TPA Claims Manager

Key Responsibilities

• Operations Oversight: Manage cashless and reimbursement claim lifecycles from initial pre-authorization to final settlement.
• Dispute Resolution: Analyze and resolve claim denials, short payments, and rejections with insurance providers.
• Team Leadership: Supervise, train, and guide TPA executives, billing staff, and front-desk coordinators.
• Compliance & Audits: Conduct internal quality audits and ensure adherence to regulatory guidelines and hospital protocols.
• Relationship Management: Maintain professional liaisons with insurance brokers, corporate clients, and TPA representatives.

Qualifications & Requirements

• Education: Bachelors degree in a relevant field; a Master’s or MBA in Healthcare Management, Hospital Administration, or Insurance is preferred.
• Experience: 5 to 10 years of total experience in health insurance desk operations, general insurance claims processing, or TPA management.
• Core Skills: Strong analytical capabilities, deep knowledge of medical billing terminologies, and proficiency in hospital management software.