Senior Executive : TPA

Job Title: Senior Executive - TPA

Company: Manipal Hospitals

Job Description:
Manipal Hospitals is seeking a Senior Executive for the Third Party Administrator (TPA) department. The ideal candidate will be responsible for managing TPA operations, ensuring seamless coordination between the hospital and various insurance providers. This role involves overseeing claims processing, resolving disputes, and maintaining effective communication with all stakeholders to enhance patient experience and operational efficiency.

Key Responsibilities:

• Manage day-to-day TPA operations, including claim submissions and follow-ups.
• Coordinate with insurance companies to ensure timely approvals and reimbursements.
• Review and process claim documents and ensure compliance with hospital policies and insurance guidelines.
• Address and resolve any disputes or issues related to claims in a professional manner.
• Maintain accurate records of all transactions and communications with TPAs and insurance providers.
• Train and mentor junior staff in TPA operations and processes.
• Monitor and report on TPA performance metrics to senior management.
• Collaborate with various departments within the hospital to enhance the overall patient experience.
• Participate in audits and ensure adherence to regulatory requirements.

Skills and Tools Required:

• Strong understanding of healthcare insurance processes and TPA operations.
• Excellent communication and interpersonal skills.
• Analytical skills for processing claims and resolving disputes.
• Proficient in MS Office Suite (Word, Excel, PowerPoint).
• Familiarity with hospital management software and claim processing tools.
• Ability to work collaboratively in a fast-paced environment.
• Strong attention to detail and organizational skills.
• Experience in a healthcare setting, particularly in insurance or TPA roles, is preferred.

Join Manipal Hospitals and be a vital part of our commitment to providing quality healthcare through effective management of TPA operations.