K.J. Somaiya Hospital & Research Centre, a 550-bedded medical college and hospital in Sion, Mumbai, is hiring an Incharge - TPA to lead its TPA, MJPJAY and Corporate department.

Roles and Responsibilities

- Prepare and implement SOPs for smooth functioning of the TPA department
- Handle empanelment of TPAs, MJPJAY and Corporates and ensure renewal of MOUs within TAT
- Negotiate best rates and discounts with TPAs, MJPJAY and Corporates
- Oversee daily admissions, discharges, TPA queries, claims, reimbursements and outstanding payments
- Supervise accurate billing of TPA, MJPJAY and Corporate patients as per MOU terms
- Verify pre-authorisation and final approval letters
- Cross-check final bills and discharge summaries before submission to TPAs
- Ensure complete claim files are sent to TPA, MJPJAY and Corporates within timelines
- Ensure recovery of payments within TAT and follow up on delayed or pending payments, including visits to TPA offices when required
- Ensure payment settlements are updated in the system within TAT
- Coordinate with patients, consultants and management for CABG package billing
- Guide patients and relatives on deductions and ensure settlement for cashless cases




- Resolve patient grievances and reimbursement claim queries
- Conduct regular training for departmental staff
- Prepare and submit monthly MIS reports to management
- Coordinate with other departments for smooth functioning

Desired Candidate Profile

- Medical graduate (MBBS / BAMS / BHMS) is mandatory
- Valid registration with the respective Maharashtra council
- Experience in handling TPA, MJPJAY and corporate billing in a hospital setup
- Strong knowledge of cashless and reimbursement processes and TPA portals
- Good understanding of medical terminology, hospital billing and MOU terms
- Negotiation, liaison and team leadership skills
- Good command of MS Excel and hospital software

Perks and Benefits

- Opportunity to lead the TPA department of a 550-bedded medical college and hospital
- Structured working workplace with exposure to TPA, MJPJAY and corporate accounts
- Salary as per qualification and hospital norms

The roles and responsibilities mentioned above are indicative and may be modified from time to time as per organisational requirements. * Immediate joiners or candidates with a short notice period will be preferred

📌 Incharge - TPA (Doctor) (Mumbai)
🏢 K.J. Somaiya Hospital u0026 Research Centre
📍 Mumbai