TPA Head

The TPA Head will be responsible for overseeing all Third-Party Administrator (TPA) and insurance-related activities in the hospital. The role involves managing cashless processes, billing approvals, claims settlement, coordination with insurance companies, and ensuring compliance with regulatory requirements.

Key Responsibilities:

1. Operations Management

• Supervise and monitor the entire TPA and insurance operations of the hospital.
• Ensure timely and accurate processing of pre-authorizations, approvals, and discharge summaries.
• Maintain coordination between patients, doctors, billing, and TPA executives for smooth cashless operations.
• Oversee the claim submission process and follow up on pending or rejected claims.
• Ensure accuracy of documentation and adherence to insurance/TPA guidelines.

2. Financial & Claims Management

• Review and approve all insurance and TPA-related bills before submission.
• Monitor claim settlements and ensure timely payments from insurance companies.
• Track receivables, reconcile accounts, and minimize claim rejections.
• Prepare MIS reports on TPA collections, outstanding claims, and rejections.

3. Coordination & Liaison

• Build and maintain strong relationships with TPA representatives and insurance companies.
• Liaise with consultants and clinical teams for proper documentation and justification of medical procedures.
• Act as a point of escalation for complex or disputed cases.

4. Team Management

• Lead, train, and monitor the TPA team to ensure efficiency and service quality.
• Allocate responsibilities and monitor daily operations to maintain turnaround times.

5. Compliance & Quality

• Ensure compliance with hospital policies and IRDA guidelines.
• Periodically audit insurance files and claim documentation.
• Implement continuous process improvement in TPA operations.

Key Skills & Competencies:

• Strong knowledge of hospital billing, insurance procedures, and TPA processes
• Excellent communication and negotiation skills
• Analytical and problem-solving ability
• Team leadership and multitasking skills
• Proficiency in hospital billing software and MS Office

Qualification:

• Graduate in any discipline (preferably BAMS / BHMS / BHA)
• Experience: Minimum 5–6 years in TPA/Insurance coordination

Job Type: Full-time

Work Location: In person