About the Role

MOC Cancer Care & Research Centre is looking for an experienced TPA Manager to oversee all Third-Party Administrator (TPA), insurance, and corporate billing operations. The ideal candidate should have extensive experience in managing cashless claims, insurance documentation, empanelment's, claim settlements, and coordinating with insurance companies, TPAs, corporate clients, and internal stakeholders to ensure a seamless patient experience.

Key Responsibilities

TPA & Insurance Operations

- Manage end-to-end cashless hospitalization and reimbursement processes.
- Coordinate with TPAs, insurance companies, and corporate clients for claim approvals and settlements.
- Ensure timely submission of pre-authorization requests and final claim documents.
- Track pending approvals, claim status, and settlement timelines.
- Resolve claim-related discrepancies and coordinate for quick resolution.

Billing & Documentation

- Ensure accurate preparation and submission of claim documents.
- Verify patient records, bills, discharge summaries, and supporting medical documents.
- Monitor rejected and short-settled claims and initiate corrective actions.
- Maintain complete documentation as per TPA and insurance guidelines.

Corporate & TPA Relationship Management

- Build and maintain solid relationships with TPAs,



insurance companies, and corporate clients.
- Coordinate with empanelment teams for new tie-ups and renewals.
- Attend meetings with insurance representatives whenever required.

Team Management

- Supervise and guide the TPA and billing team.
- Allocate daily work and monitor team productivity.
- Train staff on insurance policies, documentation standards, and claim procedures.

Compliance & Reporting

- Ensure compliance with hospital policies, insurance guidelines, and regulatory requirements.
- Prepare daily, weekly, and monthly MIS reports on:
- Cashless approvals
- Claim settlements
- Outstanding claims
- Rejections
- TAT analysis

- Identify process improvement opportunities to enhance operational efficiency.

Required Qualifications

- Bachelor's degree in Healthcare Administration, Hospital Management, Commerce, or a related field.
- Master's degree in Hospital Administration (preferred).

Experience

- 5-8 years of experience in TPA, insurance, or hospital billing.
- Prior experience in a multi-specialty hospital or oncology hospital is preferred.
- Hands-on experience handling major TPAs and insurance companies.

Interested candidates can WhatsApp their resume to Neha Gala: (phone hidden)

📌 Tpa Manager (Mumbai)
🏢 Cellcure Cancer Centre
📍 Mumbai