- Lead and supervise TPA operations across all hospital centres.
- Ensure smooth handling of cashless and insurance patients from admission to final discharge.
- Manage pre-authorisation requests, approval, enhancement, discharge approval, and final settlement.
- Coordinate with all major TPAs, insurance companies, corporate clients, and government schemes, as applicable.
- Monitor pending approvals, queries, deductions, rejected claims, and delayed settlements.
- Ensure timely submission of complete and accurate claim documents.
- Review TPA billing, claim files, discharge summaries, medical documents, investigation reports, and supporting documents.
- Coordinate with doctors and clinical departments for required medical documentation.
- Coordinate with the Billing, Accounts, Medical Records, Nursing, Front Office, and Operations teams.
- Establish standard TPA processes and ensure implementation across all centres.
- Monitor centre-wise TPA outstanding, pending claims, ageing, deductions, and collection status.
- Review and control claim rejection and deduction percentages.
- Resolve escalated TPA and insurance-related issues.
- Maintain regular communication with TPA/insurance representatives for approvals and settlements.
- Conduct periodic audits of TPA files and identify documentation or process gaps.
- Prepare daily, weekly, and monthly MIS reports for management.




- Track centre-wise TPA performance and provide corrective action plans where required.
- Train and guide TPA executives and billing teams at all centres.
- Ensure proper handover and coordination between TPA and Accounts departments for payment reconciliation.
- Maintain updated records of TPA agreements, tariffs, packages, empanelment documents, and contact details.
- Support management during negotiations, renewals, empanelment, and tariff discussions with TPAs and insurance companies.
- Ensure compliance with hospital policies, contractual requirements, and applicable insurance/TPA processes.

Key Performance Indicators (KPIs)
- TPA approval turnaround time
- Cashless approval rate
- Claim submission turnaround time
- Claim settlement percentage
- TPA outstanding and ageing
- Claim rejection percentage
- Claim deduction percentage
- Pending enhancement cases
- Pending discharge approvals
- Query resolution time
- Centre-wise TPA revenue and collection
- Documentation accuracy
- TPA patient satisfaction
- Timely reconciliation of TPA payments

7–10+ years of relevant experience, preferably in a multi-centre hospital or healthcare group.

Pay: ₹90,000.00 - ₹100,000.00 per month

Perks

- Flexible schedule

Work Location: In person

📌 TPA HEAD (Tilak Nagar)
🏢 Aastha Hospital
📍 Tilak Nagar