Job Summary
The Head – TPA & Insurance Operations is responsible for leading and managing all Third-Party Administrator (TPA), insurance, and corporate healthcare business functions of the hospital. The role ensures productive pre-authorization, claims processing, timely reimbursements, denial management, payer relationship management, and compliance with insurance and regulatory requirements. The incumbent will drive revenue realization, optimize cash flow, improve patient experience, and strengthen strategic partnerships with TPAs, insurers, and corporate clients.
Key Responsibilities
TPA & Insurance Operations Management
- Lead end-to-end TPA and insurance operations, including pre-authorizations, cashless approvals, claims submission, and settlements.
- Ensure seamless coordination between patients, clinical teams, billing departments, TPAs, and insurance companies.
- Monitor and improve claim processing efficiency and turnaround times.
- Develop and implement standardized operating procedures (SOPs) for insurance and TPA operations.

Claims & Revenue Cycle Management




- Oversee submission, tracking, reconciliation, and closure of insurance claims.
- Ensure timely collection of receivables from TPAs and insurance companies.
- Analyze claim rejections, denials, deductions, and underpayments.
- Implement corrective actions to minimize revenue leakage and improve collection efficiency.
- Monitor aging reports and drive recovery of outstanding payments.

Relationship Management
- Build and maintain strong relationships with TPAs, insurance companies, corporate clients, and government health schemes.
- Negotiate commercial terms, tariffs, package rates, and service-level agreements.
- Conduct regular review meetings with payers to address operational and financial concerns.
- Support empanelment and renewal processes with insurance providers and corporate organizations.

Team Leadership
- Lead and mentor TPA executives, insurance coordinators, billing teams, and claims

📌 Head - TPA (Dombivli)
🏢 Jupiter Hospital
📍 Dombivli