Manager (TPA -Operations)

Key Responsibilities

• Monitor Network and reimbursement claim settlement.
• Ensure the claims are processed within the agreed TAT as per Insurer SLA
• Establish claim adjudication guidelines and governance frameworks.
• Monitor TPA performance against SLAs as per Metrics.
• Follow up monthly operational reviews with MIS team.
• Coordination with Insurer on daily basis for Rejection and approval claims
• Resolve service issues and escalations from Insurer.
• Ensure compliance with insurer guidelines.
• Preparing reports

Key Skills

• Health claims management.
• TPA governance.
• Fraud risk assessment.
• Data analytics.
• SLA compliance.
• TPA quality scores.
• Operational efficiency.
• Excel knowledge
• Claims adjudication
• Analytical ability