Qualifications
- Bachelor's Degree in Hospital Administration, Commerce, Finance, or related field.
- MHA/MBA (Healthcare Management) preferred.
- Certification in Health Insurance/TPA Management is an added advantage.
Experience
- 5–8 years of experience in TPA, insurance, or hospital billing operations.
- Minimum 2–3 years in a managerial role.
- Experience in NABH-accredited hospitals preferred.
JD-
- Manage end-to-end cashless hospitalization processes.
- Ensure timely submission of pre-authorization requests.
- Coordinate with TPAs and insurance companies for approvals.
- Monitor claim processing and settlement status.
- Ensure smooth admission and discharge processes for insured patients.
- Review claim documents for completeness and accuracy.
- Ensure timely submission of final bills and claim documents.
- Track pending claims and follow up for settlements.
- Manage claim rejections, deductions, and appeals.
- Minimize claim denial and revenue loss.
- Maintain strong relationships with TPAs, insurance companies, and corporate clients.
- Conduct regular meetings with insurance representatives.
- Resolve escalated claim and authorization issues.
- Support empanelment and renewal of TPAs and corporates.
- Monitor insurance receivables and outstanding payments.
- Analyze deduction trends and implement corrective actions.
- Ensure maximum realization of approved claims.
- Coordinate with Finance and Billing Departments for reconciliation.
- Supervise TPA executives and coordinators.
- Allocate work and monitor team productivity.
- Conduct regular training on insurance guidelines and documentation.
- Ensure compliance with departmental SOPs.
- Guide patients and attendants regarding insurance procedures.
- Address insurance-related concerns and grievances.
- Ensure transparent communication regarding approvals and exclusions.
- Facilitate hassle-free discharge for insured patients.
- Ensure compliance with IRDAI guidelines, hospital policies, and NABH standards.
- Maintain accurate records of approvals, claims, settlements, and deductions.
- Support internal and external audits.
- Maintain confidentiality of patient and insurance records.
- Prepare daily, weekly, and monthly TPA reports.
- Monitor approval rates, claim settlements, and outstanding receivables.
- Present departmental performance reports to management.
- Analyze trends and recommend process improvements.
Pay: ₹30,000.00 - ₹40,000.00 per month
Benefits:
Work Location: In person
