- The Senior TPA Manager is responsible for managing all Third Party Administrator (TPA) and insurance-related processes, ensuring smooth cashless approvals, timely claim processing, and maintaining strong relationships with insurance companies and TPAs.
Key Responsibilities:
- Handle end-to-end TPA operations for IPD & OPD cases
- Coordinate with doctors, billing, and front office teams for documentation
- Monitor and follow up on pending claims and rejections
- Ensure proper submission of online & offline claims
- Manage escalations related to insurance and TPA issues
- Maintain robust relationships with insurance companies & TPAs
- Train and supervise TPA executives and billing staff
- Prepare daily, weekly,
and monthly MIS reports
- Handle audits related to insurance and TPA processes
Key Skills & Competencies:
- Strong knowledge of TPA processes and insurance policies
- Experience in eye hospital or healthcare setup preferred
- Good communication and negotiation skills
- Problem-solving and decision-making skills
- Proficiency in hospital management systems and MS Office
Experience:
- Minimum 5-15 years of experience in TPA/Insurance department
- At least 5-8 years in a senior or managerial role
- # Immediate Joiner