TPA Manager

Role Overview

The TPA Manager will be responsible for overseeing all operations related to private insurance, TPAs, and government health schemes including Bhamashah Swasthya Bima Yojana (BSBY) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY). The role ensures smooth cashless and reimbursement processes, timely approvals, and compliance with all scheme guidelines.

Key Responsibilities

• Manage and coordinate with TPAs and insurance providers for cashless and reimbursement claims.
• Handle all processes under BSBY and PMJAY, ensuring compliance and efficient claim settlements.
• Ensure timely pre-authorization, approvals, and discharges for insured and scheme patients.
• Guide patients and families about insurance / TPA / BSBY / PMJAY eligibility, documentation, and claim processes.
• Maintain accurate records, MIS reports, and documentation for audits and scheme compliance.
• Coordinate with billing, admissions, accounts, and medical teams for seamless claim management.
• Monitor and review TPA and government scheme agreements, policies, and guidelines.
• Track claim trends, identify gaps, and recommend improvements to reduce denials.
• Build and maintain strong relationships with TPAs, insurance companies, and government scheme authorities.

Qualifications & Skills

What We Offer