- Operations Oversight: Manage cashless and reimbursement claim lifecycles from initial pre-authorization to final settlement.
- Dispute Resolution: Analyze and resolve claim denials, short payments, and rejections with insurance providers.
- Team Leadership: Supervise, train, and guide TPA executives, billing staff, and front-desk coordinators.
- Compliance & Audits: Conduct internal quality audits and ensure adherence to regulatory guidelines and hospital protocols.
- Relationship Management: Maintain qualified liaisons with insurance brokers, corporate clients, and TPA representatives.
Qualifications & Requirements
- Education: Bachelors degree in a relevant field; a Master’s or MBA in Healthcare Management, Hospital Administration, or Insurance is preferred.
- Experience: 5 to 10 years of total experience in health insurance desk operations, general insurance claims processing, or TPA management.
- Core Skills: Strong analytical capabilities, deep knowledge of medical billing terminologies, and proficiency in hospital management software.