TPA - Manager

1 day ago

Delhi, Delhi, India Mantra Care Full time ₹ 14,40,000 - ₹ 25,20,000 per year

Job Title: Manager – TPA & Insurance Operations

Location: Eye Mantra Hospital, Pachim Vihar, Delhi

Contact Person: Rizwana (HR) – or

Pay: ₹ 20,000 – ₹ 25,000 per month

Key Responsibilities

  • Lead and oversee the entire insurance / TPA process: verification, documentation, submission of claims to insurers and TPAs, ensuring end-to-end accountability.
  • Manage empanelment drives: establish, maintain and review hospital empanelments with insurance companies and TPAs; negotiate contracts and service-level agreements.
  • Supervise patient assistance operations: lead a team that guides patients through insurance policy details, claim queries, cashless admissions, and discharge billing coordination.
  • Oversee billing, documentation and reconciliation: ensure accurate billing, timely submission of interim and final bills, coordinate with Finance for settlement and recovery of claims.
  • Ensure compliance and generate management reporting: maintain regulatory standards, audit readiness, maintain MIS dashboards, track claim rejection rates, outstanding balances, recovery metrics.
  • Team leadership & continuous improvement: recruit/train/mentor staff, set performance targets, establish standard operating procedures (SOPs), drive process enhancements to improve turnaround times and reduce claim repudiations.
  • Stakeholder management: interface with internal departments (billing, medical records, nursing, consultants), external insurers/TPAs, and senior hospital leadership to escalate and resolve major issues.

Skills & Qualifications

Experience:

  • Minimum 3-5 years (or more) of experience in TPA/insurance operations within a healthcare setting (ophthalmology or multi-specialty hospital preferred).
  • Prior experience in billing, insurance verification, claim management, empanelment and recovery.
  • Proven experience in managing a small team, driving operational targets and taking ownership of end-to-end processes.

Education:

  • Bachelor's degree in any stream (preferably in Healthcare Administration, Insurance, Medical Billing, Business Administration).
  • Certification or training in medical billing, insurance operations, or hospital administration is a plus.

Skills:

  • Strong knowledge of insurance policies, TPAs, pre-auth/billing/claims processing terminology and processes.
  • Excellent communication, negotiation and stakeholder management skills.
  • Proficiency in MS Office (especially Excel), hospital information system (HIS) or billing systems.
  • Analytical mindset with ability to monitor KPIs (e.g., claim turnaround time, rejection rate, outstanding balances) and implement corrective actions.
  • Leadership qualities: ability to motivate, coach, and develop team members; drive process improvements.
  • Attention to detail, problem-solving aptitude, ability to work under pressure and adapt to changing priorities.

Reporting & Team Structure

  • The Manager will report to the Head of Finance / Hospital Operations and will be responsible for a team of TPA/billing executives.
  • Will set team-goals, monitor performance, conduct reviews and escalate critical issues to senior management.

Job Type: Full-time

Pay: ₹30, ₹45,000.00 per month

Work Location: In person

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