TPAs - Relationship manager - Sr. Executive/Assistant Manager

2 days ago

Delhi, Delhi, India Centre For Sight Full time ₹ 5,00,000 - ₹ 15,00,000 per year

Role Overview:

The Insurance Relationship Manager acts as the primary liaison between the hospital and health insurance stakeholders, including Third-Party Administrators (TPAs), insurance companies, and corporate clients. The role ensures seamless facilitation of pre-authorizations, cashless claims, patient counseling on insurance coverage, and timely claim settlements, while maintaining regulatory compliance and patient satisfaction.

Key Responsibilities:

TPA & Insurance Coordination

  • Act as the main point of contact between the hospital and all empaneled TPAs and insurance companies.
  • Manage the empanelment and re-empanelment process of insurance providers.
  • Build and maintain strong relationships with insurance company representatives.

Claim Submission & Settlement

  • Ensure timely and error-free claim submissions post-discharge.
  • Monitor claim status and coordinate with insurance/TPA for swift settlement.
  • Resolve discrepancies, rejections, and pending queries from TPAs or insurers.

Reporting & Compliance

  • Maintain MIS and dashboards for insurance claims, approvals, rejections, and settlements.
  • Ensure compliance with hospital policies and IRDAI guidelines.
  • Coordinate audits with TPAs and insurance companies.

Key Skills:

  • Strong knowledge of health insurance policies, TPAs, and IRDAI regulations
  • Excellent communication and interpersonal skills
  • Familiarity with hospital management systems (HMS), insurance portals
  • Problem-solving and negotiation skills
  • Attention to detail and documentation accuracy

Preferred Experience:

  • Worked in a hospital TPA desk or revenue cycle management (RCM) team
  • Familiarity with cashless and reimbursement claim processes
  • Relationships with multiple TPAs and insurance companies

Qualifications:

  • Bachelors degree in Healthcare Management, Insurance, Business Administration, or a related field.
  • Preferred: PG Diploma in Hospital Administration or Insurance Management.
  • Experience: 2 - 5 years in hospital billing/insurance/TPA coordination roles.

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