Key Responsibilities

- Manage end-to-end TPA and insurance operations, ensuring timely pre-authorizations, claim submissions, and payment follow-ups.
- Drive process improvement initiatives to enhance operational efficiency, reduce claim rejections, and optimize workflows.
- Monitor and improve Turnaround Time (TAT) for pre-authorizations, discharge clearances, claim submissions, and query resolution.
- Coordinate with insurance companies, TPAs, clinical teams, billing, and medical records to ensure accurate documentation and seamless claim processing.
- Analyze claim rejection trends and implement corrective actions to improve approval rates and minimize revenue leakage.
- Develop and monitor departmental KPIs, including TAT compliance, pending claims, ageing analysis, and claim settlement performance.
- Lead, mentor, and train the TPA team on SOPs, documentation standards, and quality processes.
- Ensure compliance with hospital policies, insurance guidelines, and NABH standards.




- Prepare MIS reports and dashboards for management review, highlighting operational performance and improvement initiatives.
- Support panel billing operations, including government and corporate schemes, as required.

Required Skills

- Robust knowledge of TPA and health insurance claim processes.
- Expertise in process improvement, TAT management, SOP implementation, and quality initiatives.
- Excellent analytical, problem-solving, communication, and stakeholder management skills.
- Proficiency in Hospital Information Systems (HIS), Microsoft Excel, and MIS reporting.
- Strong leadership and team management abilities.

Qualification

- Graduate in any discipline (Healthcare/Hospital Management preferred).
- MBA/MHA or PG Diploma in Hospital Administration will be an added advantage.

Regards

Shobhit Nayal

(phone hidden)

📌 Tpa Manager (Gurugram)
🏢 Medanta
📍 Gurugram