Manager – TPA

2 days ago

Delhi, Delhi, India MantraCare Full time ₹ 12,00,000 - ₹ 36,00,000 per year

Job Title:
Manager – TPA & Empanelment

Location:
Eye Mantra Hospital - Paschim Vihar

Department:
Administration

Apply:



Job Summary

Eye Mantra Hospital is seeking a highly experienced
TPA & Empanelment Manager
with a strong background in
eye/ophthalmology hospitals
. The candidate will be responsible for managing insurance operations, ensuring smooth and timely claim processing, handling empanelment with various payers, and building strong partnerships with TPAs and insurance companies. Prior experience in an
eye care setup
is essential to efficiently manage ophthalmology-specific procedures, packages, coding, and claims.

Key Responsibilities

  • Lead and manage TPA operations specific to
    ophthalmology services
    , ensuring accurate documentation and claim processing for eye procedures.
  • Drive empanelment with
    insurance companies, corporates, and government health schemes
    with a focus on ophthalmology packages (cataract, LASIK, retina, glaucoma, etc.).
  • Oversee contract renewals, tariff negotiations, package updates, and ensure compliance with eye-care–specific empanelment terms.
  • Build and maintain strong relationships with TPAs, insurance partners, corporate clients, and government health bodies.
  • Prepare insurance-related MIS, package performance reports, and revenue insights for senior management.
  • Handle escalations related to patients, insurance claims, approvals, pre-authorizations, and TPA processes.
  • Coordinate with ophthalmology consultants, billing teams, and patient coordinators to ensure smooth insurance workflows.
  • Stay updated with the latest insurance guidelines, Ayushman Bharat schemes, and policies relevant to
    eye care
    .

Qualifications & Experience

  • Bachelor's or Master's degree in
    Healthcare Administration / Business Management
    or related fields.
  • 5–8 years of experience
    in TPA operations or hospital empanelment
    specifically in an eye hospital or ophthalmology center
    (minimum
    2 years in a managerial role
    ).
  • Strong understanding of
    ophthalmic procedures, coding, insurance packages, and claim documentation
    .
  • Experience using hospital management software and insurance portals.
  • Excellent communication, negotiation, and analytical skills.

Key Skills

  • Leadership & Team Management
  • Ophthalmology Insurance & TPA Knowledge
  • Empanelment & Contract Negotiation
  • Relationship & Stakeholder Management
  • Compliance & Regulatory Knowledge
  • Problem Solving & Conflict Resolution
  • Eye-care–specific billing & documentation expertise

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