JOB DESCRIPTION – TPA MANAGER
Department: TPA / Insurance
Designation: TPA Manager
Industry: Hospital / Healthcare
Experience: 3–6 Years
Job Type: Full Time
Location: Pulmonic A Multispeciality Hospital, Raj Nagar, Ghaziabad
Job Summary
We are looking for an experienced and responsible TPA Manager to manage the hospital’s TPA, insurance and government health scheme operations. The candidate will be responsible for smooth cashless approvals, claim processing, documentation, billing coordination, follow-ups and timely settlement of claims.
Key Responsibilities
- Manage complete TPA, Insurance and Cashless operations of the hospital.
- Handle CGHS, ECHS, Ayushman Bharat / PM-JAY and other government health schemes.
- Coordinate with TPA/Insurance companies for pre-authorisation and cashless approvals.
- Verify patient eligibility, policy details, coverage and package entitlement.
- Ensure timely submission of pre-authorisation requests, extensions and final claims.
- Coordinate with doctors, nursing, billing, pharmacy, diagnostics and other departments for required documentation.
- Ensure accurate preparation and submission of claim files and supporting documents.
- Handle claim queries, deductions, rejections and pending cases.
- Follow up with TPA/Insurance companies for outstanding claims and payments.
- Maintain proper records of approved, pending, rejected and settled claims.
- Monitor claim ageing, outstanding amount and settlement status.
- Identify reasons for claim deductions/rejections and take corrective action.
- Ensure compliance with TPA, insurance and government scheme guidelines.
- Maintain proper documentation for audit and inspection purposes.
- Guide and supervise the TPA/Insurance team and allocate daily work.
- Prepare daily/weekly/monthly TPA MIS reports for management.
- Coordinate with accounts and billing departments for reconciliation of TPA payments.
- Maintain good professional relationships with TPA/Insurance representatives.
- Ensure confidentiality and proper handling of patient and financial information.
Required Skills
- Strong knowledge of Hospital TPA & Insurance Process.
- Good knowledge of CGHS, ECHS and Ayushman/PM-JAY procedures.
- Knowledge of cashless hospitalization and claim settlement process.
- Good communication and negotiation skills.
- Strong documentation and follow-up skills.
- Good knowledge of MS Excel, MS Word and hospital billing/TPA software.
- Ability to manage a team and work under pressure.
- Good problem-solving and decision-making skills.
Qualification
Bachelor’s degree in any discipline preferred.
Hospital Administration / Healthcare Management / Insurance-related qualification will be an added advantage.
Experience
Minimum 3 years of relevant experience in Hospital TPA / Insurance Department, preferably with experience in CGHS, ECHS and Ayushman/PM-JAY.
Key Performance Areas (KPI)
- Timely cashless approvals
- Reduction in claim rejection and deductions
- Timely claim submission
- Reduction in outstanding claims
- Faster claim settlement
- Accurate documentation
- Effective team management
- TPA/Insurance coordination
Reporting To: Hospital Administration / Management
Pay: ₹18,000.42 - ₹35,000.62 per month
Benefits:
- Cell phone reimbursement
- Commuter assistance
- Flexible schedule
- Food provided
- Paid sick time
- Paid time off
- Provident Fund
Work Location: In person
