TPA Manager

About the job

Job Summary: The TPA Manager will be responsible for managing all insurance and TPA-related activities at the Paschim Vihar center, ensuring smooth cashless and reimbursement processes, timely claim settlements, and excellent patient experience for insured cases. Key Responsibilities: • Handle end-to-end TPA & insurance desk operations at the Paschim Vihar hospital • Coordinate with TPAs, insurance companies, and corporate clients • Manage pre-authorizations, approvals, extensions, and denials • Ensure accurate documentation, coding, and claim submission • Follow up for pending claims, payments, and settlements • Minimize claim rejections and deductions through strong process control • Resolve patient and insurer escalations related to insurance cases • Maintain updated TPA empanelments, MOUs, and rate cards • Coordinate with doctors, billing team, MRD, and front office • Ensure compliance with IRDA guidelines and hospital SOPs • Prepare and present daily, weekly, and monthly MIS reports • Train, guide, and monitor TPA executives / insurance desk staff Required Qualifications & Experience: • Graduate in any discipline (MBA in Healthcare Management preferred) • 3–6 years of relevant experience in hospital TPA/insurance management • Strong knowledge of eye hospital procedures (cataract, LASIK, retina, etc.) is preferred • Hands-on experience with cashless & reimbursement claims • Familiarity with major TPAs & insurance companies • Proficient in HIS, billing software, and MS Excel • Excellent communication, coordination, and negotiation skills Key Skills: • Claim management & documentation • Insurance negotiation & follow-ups • Process improvement & compliance • Team handling & patient communication KPIs / Performance Metrics: • Claim approval and settlement turnaround time (TAT) • Reduction in claim rejections & deductions • Patient satisfaction for insured cases • Accuracy and timeliness of MIS reporting.

Requirements

• Claim management & documentation
• Insurance negotiation & follow-ups
• Process improvement & compliance
• Team handling & patient communication

Qualifications

• Graduate in any discipline
• 3–6 years of experience in hospital TPA/insurance management

Preferred Technologies

• Claim management & documentation
• Insurance negotiation & follow-ups
• Process improvement & compliance
• Team handling & patient communication

About the company

Eye Mantra Hospital is a leading super-specialty eye care hospital providing advanced treatments including cataract surgery, LASIK, refractive surgery, retina, glaucoma, cornea, and pediatric ophthalmology. We are committed to delivering high-quality, patient-centric eye care with transparent and efficient insurance processes.