Job Description – TPA Manager (Hospital)Position
TPA Manager
Department
TPA / Billing / Corporate Relations
Location
Pulmonic A Multispeciality Hospital
Reports To
Hospital Administrator / Medical Superintendent
Job Summary
We are looking for an experienced TPA Manager to oversee all Third Party Administration (TPA), Corporate, Government Health Scheme, and Cashless Insurance operations of the hospital. The candidate must have sound knowledge of CGHS, ECHS, Ayushman Bharat (PM-JAY), private insurance TPAs, and hospital billing processes. The role requires coordination with patients, insurance companies, government authorities, and internal departments to ensure smooth cashless approvals and timely claim settlements.
Key Responsibilities
- Manage complete TPA department operations.
- Handle CGHS, ECHS, Ayushman Bharat (PM-JAY), and private insurance claims.
- Process cashless authorization requests and obtain approvals within stipulated timelines.
- Coordinate with insurance companies, TPAs, corporate clients, and government agencies.
- Verify patient eligibility, policy coverage, and required documentation.
- Ensure accurate preparation and submission of pre-authorization, enhancement requests, and final claim documents.
- Monitor claim status and follow up for approvals, settlements, and outstanding payments.
- Resolve claim rejections, deductions, and disputes with TPAs and insurance companies.
- Maintain proper documentation and records of all claims.
- Coordinate with Billing, Front Office, Nursing, Doctors, Pharmacy, and Accounts departments.
- Ensure compliance with hospital policies, TPA guidelines, CGHS, ECHS, and PM-JAY regulations.
- Prepare daily, weekly, and monthly MIS reports related to TPA operations.
- Develop and maintain relationships with insurance companies, TPAs, and corporate clients.
- Train and supervise TPA executives and billing staff.
Required Skills
- Strong knowledge of CGHS, ECHS, Ayushman Bharat (PM-JAY), and private insurance TPAs.
- Expertise in hospital billing and medical documentation.
- Knowledge of cashless authorization and reimbursement processes.
- Excellent communication and negotiation skills.
- Good knowledge of medical terminology and coding.
- Ability to manage multiple claims simultaneously.
- Proficiency in MS Office and Hospital Information Systems (HIS).
Educational Qualification
- Bachelor's Degree in any discipline.
- Preference will be given to candidates with Hospital Administration or Healthcare Management qualifications.
Experience
- Minimum 5–8 years of experience in Hospital TPA/Insurance Management.
- Minimum 2–3 years of experience as a TPA Manager or Team Leader.
- Hands-on experience in CGHS, ECHS, Ayushman Bharat (PM-JAY), Medi Assist, Vidal Health, Paramount, FHPL, Star Health, ICICI Lombard, HDFC ERGO, Niva Bupa, and other major insurance TPAs.
Preferred Candidate Profile
- Strong leadership and team management skills.
- Excellent problem-solving ability.
- Customer-focused approach.
- Ability to work under pressure and meet deadlines.
- Professional attitude with excellent interpersonal skills.
Salary
As per experience and interview performance.
Employment Type
Full-Time
Joining
Immediate Preferred
Pay: ₹20,000.00 - ₹35,000.00 per month
Benefits:
- Cell phone reimbursement
- Commuter assistance
- Flexible schedule
- Food provided
- Paid sick time
- Paid time off
- Provident Fund
Work Location: In person
