TPA Manager

Job Title: TPA Manager
Department: Billing & Insurance
Location: ITM Hospital and Research Centre, Gwalior
Experience Required: 5 to 8 years (preferably in hospital/healthcare sector)
Reports To: Head – Billing & Finance
Salary Range: ₹30,000 to ₹60,000 per month (based on experience and qualifications)

Job Summary:

The TPA Manager will be responsible for managing all activities related to Third Party Administrators (TPAs), insurance claim processing, coordination with patients and insurance companies, timely submission and reconciliation of claims, and ensuring smooth cashless treatment processes in accordance with hospital policies and guidelines.

Key Responsibilities:

• Liaise with various TPAs, insurance companies, and government health schemes (including Ayushman Bharat) for timely authorization and claim approvals.
• Ensure accurate and timely submission of pre-authorizations, interim, and final claims.
• Track claim statuses and ensure recovery of pending dues from TPAs and insurers.
• Monitor cashless treatment processes and coordinate with medical, billing, and admission teams.
• Maintain and update all TPA-related documentation, agreements, and tariffs.
• Handle patient queries related to insurance and assist in resolving issues.
• Regularly follow up on claim rejections and provide justification or additional documents.
• Generate MIS reports on claim status, collections, and rejections for management review.
• Train and guide team members on insurance-related protocols and compliance requirements.
• Ensure compliance with NABH standards and hospital billing policies.

Qualifications & Skills:

• Graduate/Postgraduate in Hospital Administration, Commerce, or related field.
• 5 to 8 years of relevant experience in TPA/Insurance desk in hospitals.
• Strong knowledge of TPA functioning, insurance claims, and government healthcare schemes.
• Proficient in MS Office and hospital billing software (e.g., HIS systems).
• Excellent communication, coordination, and negotiation skills.
• Attention to detail, problem-solving, and ability to work under pressure.

Working Conditions:

• Full-time position
• Based at ITM Hospital, Gwalior
• May require extended hours during audits, peak patient loads, or emergencies

Job Type: Full-time

Pay: ₹40,000.00 - ₹60,000.00 per month

Schedule:

• Day shift

Work Location: In person