The TPA Head will be responsible for overseeing all Third-Party Administrator (TPA) and insurance-related activities in the hospital. The role involves managing cashless processes, billing approvals, claims settlement, coordination with insurance companies, and ensuring compliance with regulatory requirements.

Key Responsibilities:
Operations Management
Supervise and monitor the entire TPA and insurance operations of the hospital.
Ensure timely and accurate processing of pre-authorizations, approvals, and discharge summaries.
Maintain coordination between patients, doctors, billing, and TPA executives for smooth cashless operations.
Oversee the claim submission process and follow up on pending or rejected claims.
Ensure accuracy of documentation and adherence to insurance/TPA guidelines.
Financial & Claims Management
Review and approve all insurance and TPA-related bills before submission.
Monitor claim settlements and ensure timely payments from insurance companies.
Track receivables, reconcile accounts, and minimize claim rejections.
Prepare MIS reports on TPA collections, outstanding claims, and rejections.
Coordination & Liaison




Build and maintain robust relationships with TPA representatives and insurance companies.
Liaise with consultants and clinical teams for proper documentation and justification of medical procedures.
Act as a point of escalation for complex or disputed cases.
Team Management
Lead, train, and monitor the TPA team to ensure efficiency and service quality.
Allocate responsibilities and monitor daily operations to maintain turnaround times.
Compliance & Quality
Ensure compliance with hospital policies and IRDA guidelines.
Periodically audit insurance files and claim documentation.
Implement continuous process improvement in TPA operations.

Key Skills & Competencies:
Solid knowledge of hospital billing, insurance procedures, and TPA processes
Excellent communication and negotiation skills
Analytical and problem-solving ability
Team leadership and multitasking skills
Proficiency in hospital billing software and MS Office

Qualification:
Graduate in any discipline
Experience: Minimum 2 years in TPA/Insurance coordination

Job Type: Full time

Pay: ₹18,000.00 - ₹35,000.00 per month

Work Location: In person

📌 Tpa Executive Sahibzada Ajit Singh Nagar
🏢 Edison Hospital
📍 Sahibzada Ajit Singh Nagar