TPA Management:
Oversee the day-to-day activities of contracted TPAs.
Ensure adherence to SLAs, KPIs, and regulatory requirements.
Evaluate and monitor TPA performance through audits and reports.
Coordinate training and knowledge-sharing sessions with TPAs.
Claims Oversight:
Supervise claims adjudication, settlement, and dispute resolution.
Ensure timely and accurate claims processing.
Review complex/high-value claims and provide decision support.
Vendor Coordination:
Manage TPA onboarding, renewal, and contract negotiations.
Establish strong relationships with TPA partners to ensure smooth collaboration.
Compliance & Reporting:
Ensure TPA operations comply with IRDAI (for India) or local regulatory guidelines.
Generate reports on claims trends, fraud detection, and TPA performance.
Assist in internal/external audits and implement corrective measures.
Customer Experience:
Address and resolve escalated complaints related to TPA services.
Work with customer service teams to improve end-user satisfaction.
Job Type: Full-time
Pay: ₹25,000.00 - ₹40,000.00 per month
Work Location: In person
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