Job Description

The TPA Manager is responsible for managing the entire process related to Third-Party Administrators (TPA), ESIC, health insurance claims, cashless hospitalization, patient eligibility verification, documentation control, billing, and timely settlement of claims. Ensures compliance with hospital and insurance protocols while maintaining positive relationships with TPAs and insurance partners.

Key Responsibilities:

TPA/ ESIC Operations & Coordination

Handle all TPA and insurance-related processes for cashless and reimbursement patients. Verify insurance coverage / patient eligibility before admission. Obtain pre-authorization approvals, extensions, and timely discharge approvals from TPAs. Coordinate between TPA desk, billing department, nursing teams, and consultants for smooth operations.

Documentation & Claim Management

Ensure accurate and complete documentation for all insurance cases. Submit claims within stipulated timelines and maintain track of receivables. Review treatment records, bills, and reports to avoid deductions and claim rejections.

Relationship & Liaison

Maintain strong communication and professional relationship with TPA/Insurance executives. Attend meetings, negotiate tariffs & finalize MOUs with TPAs. Resolve claim disputes and rejections with proper justification.
Job Type: Full-time

Work Location: In person