Location: Kandivali, Mumbai, Maharashtra

Department: TPA / Insurance / Billing

Designation: TPA Manager

1. Job Summary The TPA Manager will be responsible for managing the hospital's Third-Party Administrator (TPA), health insurance, and cashless patient services. The role involves coordinating with insurance companies, TPAs, patients, doctors, and internal departments to ensure timely pre-authorizations, claim processing, documentation, and settlement of insurance claims.

2. Key Responsibilities

A. TPA and Insurance Coordination

- Manage day-to-day TPA and health insurance operations within the hospital.
- Coordinate with insurance companies, TPAs, and corporate clients regarding cashless treatment and reimbursement claims.
- Maintain effective working relationships with insurance and TPA representatives.
- Verify insurance eligibility, policy details, coverage limits, exclusions, and other applicable terms.
- Monitor cashless approval requests and ensure timely submission of required documents.

B. Pre-Authorization and Cashless Approvals

- Supervise submission of pre-authorization requests for planned and emergency admissions.
- Coordinate with treating doctors and clinical teams to obtain medical notes, investigation reports, and treatment plans.
- Follow up on initial approvals, enhancement requests, and final authorization.
- Ensure timely communication of approval status and requirements to patients and concerned departments.
- Escalate delayed approvals and unresolved queries to the concerned insurance or TPA authority.

C. Claims Processing and Settlement

- Oversee preparation and submission of final bills and insurance claim documents.




- Ensure claims are complete, accurate, and submitted within the applicable timelines.
- Track pending, approved, queried, rejected, and settled claims.
- Coordinate with the billing department for claim reconciliation and payment follow-ups.
- Investigate claim deductions, short settlements, and rejections, and coordinate corrective action.
- Monitor outstanding insurance receivables and support timely collection of payments.

D. Documentation and Compliance

- Ensure proper maintenance of patient insurance files, claim records, approval letters, and supporting documents.
- Verify that documentation is consistent with medical records, billing details, and insurer requirements.
- Ensure compliance with hospital policies, applicable insurance procedures, and data confidentiality requirements.
- Maintain updated records of insurer and TPA requirements, rate agreements, and service-level timelines.
- Prepare reports on claim status, pending cases, deductions, and outstanding payments.

E. Team Management and Coordination

- Supervise and guide TPA executives and insurance desk staff.
- Allocate work, monitor productivity, and ensure timely processing of cases.
- Coordinate with doctors, nursing staff, medical records, billing, front office, and finance departments.
- Conduct regular reviews of pending claims and resolve operational bottlenecks.
- Train team members on documentation standards, claim procedures, and insurer-specific requirements.

Payscale- upto 90k per month Whatsapp on +91 79 7790 2756

Pay: ₹694,000.00 - ₹2,240,000.00 per year

Advantages

- Paid time off

Work Location: In person

📌 TPA MANAGER (Kandivali)
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