HOSPITAL TPA MANAGER

As a TPA (Third Party Administrator) Manager, you will be responsible for overseeing and managing the relationship between the insurance company, healthcare providers, and policyholders. Your primary role will involve ensuring the smooth processing of health insurance claims, handling grievances, and maintaining compliance with regulatory requirements. Your key responsibilities will include managing the entire health insurance claim process, from initiation to settlement. You will need to coordinate with insurance companies, hospitals, and policyholders to ensure timely processing while maintaining accuracy in documentation and compliance with regulations. Additionally, you will be required to review high-value or complicated claims and approve them based on policy guidelines. As the TPA Manager, you will serve as the primary point of contact between healthcare providers and the insurance company. It will be your responsibility to monitor the performance of the TPA team, ensuring efficient claim handling. You will also manage relationships with multiple hospitals, negotiating terms when necessary. Ensuring compliance with all insurance regulations, industry standards, and internal policies will be a crucial part of your role. You will need to stay up-to-date with changes in insurance policies and healthcare regulations, handling escalated cases and resolving disputes related to claims or policyholder grievances. In terms of team leadership, you will be expected to lead, mentor, and manage a team of claim processors and support staff. Conducting regular training sessions on claim processes, industry trends, and regulatory updates will also fall under your purview. Monitoring team performance, setting KPIs, and ensuring objectives are met will be essential for success in this role. This is a full-time position requiring a total of 10 years of work experience. The work location is in person, and the application deadline is 15/10/2024.,