Assistant Manager/Deputy Manager - TPA

Max Superspeciality Hospital, Vaishali Ghaziabad; Ghaziabad District; On-site; INR 600,000 - 1,000,000; Full time

Job summary

Max Superspeciality Hospital, Vaishali Ghaziabad, is seeking a proactive TPA professional to manage cashless and post-discharge health insurance claims. The role emphasizes timely TAT, preauthorisation follow-ups, medical scrutiny, and efficient claim adjudication within NABH standards.

The ideal candidate will have 7-12 years of TPA experience in the hospital sector, strong insurer liaison skills, and a commitment to customer satisfaction and SOP compliance.

Qualifications

• 7-12 years of experience in TPA within hospital industry.

Responsibilities

• Maintain TPA processing for cashless and post-discharge health insurance claims.
• Maintain overall TAT entry to exit.
• Respond to TPA queries and follow up for pre-authorisation.
• Perform medical scrutiny and provide medical opinions on claims.
• Adjudicate and process claims efficiently and adhere to SOPs.
• Maintain departmental records per NABH requirements.

Skills

TPA experience

Hospital industry

Job description

Greetings from Max Superspeciality Hospital, Vaishali, Ghaziabad!

We are hiring for proactive and dynamic TPA professional.

Role & responsibilities

• To be responsible for maintaining TPA Processing of cashless and all post discharge health insurance claims.
• To be responsible to maintain overall TAT entry to exit.
• TPA query reply and preauthorisation follow up with insurance company / tpa.
• Medical scrutiny and medical opinion for health insurance claims.
• Efficient in claim adjudication and claim processing.
• Maintaining and ensuring Standard Operating Procedures and protocols.
• To be responsible for keeping record for all correspondence done for TPA.
• Post discharge reconciliation for utilization of claims.
• Timely reply to internal TPA complaint portal.
• TPA discharge follow up and closure.
• Mmaintenance of departmental records as per the NABH requirement.
• Effective utilization of hospital information system, MIS generation of TPA patients.
• To display proactive cooperation and contribute to cordial inter and intra team relations, solution orientation and team solidarity. Should be cost effective.
• To participate in training programs to maintain and update your professional knowledge.
• To achieve high levels of customer satisfaction at each interaction.

Any task assigned to you by your HOD from time to time.

Preferred candidate profile

Any Graduate with 7-12 years of experience in TPA OF hospital industry.