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
Robust 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 Perks
Chance to lead the TPA department of a 550-bedded medical college and hospital
Structured working environment 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 And Research Centre
📍 Mumbai