TPA Manager

No. Of Openings

1

Designation

Manager

Employee Category

Front Office

Closing Date

28 Feb 2026

1. TPA & Insurance Operations

• Oversee end-to-end TPA processes including pre-authorizations, extensions, denials, and final settlements.

• Ensure timely submission of pre-auth and enhancement requests to TPAs/insurance companies.

• Monitor approval TATs and follow up proactively to avoid treatment delays.

• Handle cashless, reimbursement, CGHS, PSU, and corporate cases as applicable.

2. Billing & Documentation

• Ensure accurate and compliant billing as per approved packages, tariffs, and insurer guidelines.

• Coordinate with billing, medical records, and clinical teams for complete and error-free documentation.

• Verify eligibility, policy coverage, exclusions, and limits before admission.

• Ensure final bills are submitted within defined timelines.

3. Team Management

• Manage, guide, and monitor TPA executives and desk staff.

• Allocate duties, manage shift rosters, and ensure adequate coverage at ER/IPD/Discharge areas.

• Conduct regular training on insurer policies, SOPs, and system updates (BOSS/HIS).

• Handle staff performance, discipline, and escalation issues professionally.

4. Coordination & Stakeholder Management

• Act as the single point of contact for TPAs, insurance companies, and corporate clients.

• Coordinate closely with doctors, nursing, admission, billing, and finance teams.

• Attend internal meetings to resolve pending approvals, denials, and escalations.

5. Denials, Audit & Compliance

• Analyze insurance denials, short payments, and deductions and initiate corrective actions.

• Support internal and external audits by providing required data and justification.

• Ensure strict adherence to hospital SOPs, NABH guidelines, and insurer norms.

6. Patient & Attendant Handling

• Address patient/attendant queries related to insurance coverage, approvals, and deductions.

• Manage grievances and escalations politely and professionally to maintain patient satisfaction.

• Support bedside admission/discharge processes wherever applicable.

7. MIS & Reporting

• Prepare and submit daily/weekly/monthly MIS reports on:

  • Pre-auth approvals & pendency

  • Discharges & settlements

  • Denials & outstanding claims