Tpa Manager

Job highlights

• Experience in hospital TPA operations, insurance billing, and claim settlement with strong knowledge of cashless and reimbursement processes
• Manage end-to-end hospital insurance cases including approvals, billing, documentation, and claim settlements; coordinate with patients, insurers, TPAs, and hospital teams

Job Description: TPA Manager Hospital Insurance & Billing

Organisation: TRUE ARTIS

Role Overview
Manage hospital insurance cases end to end, including cashless approvals, insurance billing, reimbursement documentation and claim settlements. Coordinate with patients, insurance companies, TPAs and hospital teams to ensure accurate billing and timely collection.

Key Responsibilities

• Handle all cashless and reimbursement insurance cases from admission through final settlement.
• Verify policy eligibility, coverage, exclusions and required documents.
• Submit pre-authorisation requests, enhancement requests and final cashless approval documents.
• Coordinate with doctors and hospital teams to respond promptly to insurance and TPA queries.
• Prepare and verify hospital bills against approved tariffs, packages and insurer agreements.
• Coordinate final approvals and billing at discharge, explaining deductions and patient-payable amounts clearly.
• Prepare complete claim files and support patients with reimbursement documentation.
• Follow up on pending claims, short payments, deductions and rejected claims until resolution.
• Reconcile insurance receipts with the finance team and maintain accurate outstanding balances.
• Maintain daily trackers for approvals, claim submissions, settlements and ageing receivables.
• Support insurance and TPA empanelment, renewals and tariff coordination.

Candidate Requirements

• Prior experience in hospital TPA operations, insurance billing and claim settlement.
• Strong understanding of cashless and reimbursement processes.
• Ability to independently manage documentation, insurer queries and settlement follow-ups.
• Good communication, coordination and Excel skills.
• Strong attention to detail and ownership of pending cases.

Key Performance Measures

• Timely pre-authorisations and discharge approvals.
• Accurate billing and complete claim submissions.
• Timely claim settlements and reduced outstanding receivables.
• Effective resolution of deductions and rejected claims.