TPA Manager

4 weeks ago

Jaipur Rajasthan India, Rajasthan NIMS University Full time

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

  • Bachelor’s degree in Healthcare Management, Business Administration, or a related field.
  • 3–5 years of experience in hospital TPA/insurance management.
  • Strong understanding of health insurance, BSBY, and PMJAY processes.
  • Excellent communication, negotiation, and stakeholder management skills.
  • Ability to lead a team and coordinate across hospital departments.
  • Proficiency in hospital information systems and MS Office tools.


What We Offer

  • Opportunity to work with one of Rajasthan’s top multi-specialty hospitals.
  • A role with direct impact on patient satisfaction and healthcare accessibility.
  • Growth-driven environment with career advancement opportunities.

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