We are seeking an experienced and dynamic TPA Desk Manager to lead and manage the hospital's TPA operations. The ideal candidate will oversee cashless hospitalization processes, coordinate with insurance companies and TPAs, ensure timely claim processing, manage the TPA team, and maintain compliance with hospital policies and regulatory requirements. The role requires strong leadership, excellent communication skills and in-depth knowledge of health insurance and hospital billing processes.
Key Responsibilities
- Manage the day-to-day operations of the TPA Desk and supervise the TPA team.
- Coordinate with TPAs, insurance companies, corporate clients and government health schemes.
- Ensure timely processing of cashless authorization requests, enhancements and final approvals.
- Review patient documentation and billing to ensure accuracy before claim submission.
- Monitor claim status and ensure timely submission of pre-authorizations, discharge intimations and final bills.
- Resolve claim rejections, deductions, and settlement issues with TPAs and insurers.
- Maintain excellent coordination with Billing, Medical Records, Nursing, Consultants, and Finance departments.
- Ensure complete documentation as per TPA and insurance requirements.
- Prepare daily, weekly, and monthly MIS reports related to TPA performance and outstanding claims.
- Monitor pending approvals and expedite discharges to enhance patient satisfaction.
- Train, mentor, and evaluate the performance of TPA executives.
- Ensure compliance with NABH standards, hospital policies and insurance guidelines.
- Build and maintain strong professional relationships with TPA representatives and insurance companies.
- Identify process improvement opportunities to reduce claim turnaround time and improve collections.
Eligibility
- Graduate in any discipline (MBA/PGDM in Hospital Management preferred).
- Minimum 5–8 years of experience in hospital TPA operations, with at least 2 years in a supervisory/managerial role.
- Experience in a NABH-accredited multispeciality hospital is preferred.
- Strong knowledge of cashless insurance processes, medical billing, claim documentation and reimbursement procedures.
- Proficiency in Hospital Information Systems (HIS), MS Excel, and MS Office.
Required Skills
- Leadership and team management
- Strong communication and negotiation skills
- Knowledge of TPA and insurance regulations
- Analytical and problem-solving ability
- Excellent coordination and stakeholder management
- Attention to detail and documentation accuracy
- Ability to work under pressure and meet timelines
Salary
Salary will be commensurate with qualifications, experience and current CTC.SHARE CV TO: [email protected]
Pay: ₹25,000.00 - ₹40,000.00 per month
Work Location: In person
