TPA Executive

Role Overview

SLRD Memorial Hospital in Mathura, Uttar Pradesh, is seeking a skilled TPA Executive to oversee comprehensive Third Party Administrator (TPA), insurance, and corporate empanelment operations within the hospital environment.

Key Responsibilities

• Manage end-to-end empanelment and registration processes with TPAs and insurance companies, including government schemes such as CGHS, ECHS, ESIC, and Ayushman Bharat (AB-PMJAY).
• Liaise with TPAs and insurers to facilitate cashless medical approvals, pre-authorizations, claims processing, and timely settlements.
• Maintain accurate and complete TPA documentation and ensure prompt submission of all claims.
• Address and resolve any claim-related queries, discrepancies, deductions, and pending matters with concerned insurance entities.
• Coordinate effectively with billing, medical records, physicians, and financial departments to streamline claim workflows.
• Build and sustain professional relationships with TPAs, insurance providers, and corporate clients for smooth operational collaboration.
• Ensure adherence to hospital policies and regulatory insurance guidelines.
• Prepare Management Information System (MIS) reports and keep detailed records of TPA-related activities for reporting purposes.

Qualifications and Eligibility

• Graduate degree in any discipline preferred; degrees in Hospital Administration or Healthcare Management are advantageous.
• 2 to 5 years of proven experience handling Hospital TPA and Insurance Operations.
• In-depth understanding of hospital billing processes, cashless claim procedures, empanelment, and documentation requirements.
• Strong communication, negotiation, and interpersonal coordination skills.
• Familiarity with MS Excel and Hospital Information Systems (HIS) considered beneficial.

What the Hospital Offers

• Competitive salary that reflects experience and expertise.
• Opportunities to grow professionally within a supportive work culture.
• A chance to lead and develop the hospital’s entire TPA function for a growing multi-specialty institution.