Manager- TPA Insurance

Aster DM Healthcare; Hyderabad; On-site; INR 1,200,000 - 2,400,000; Full time

Job summary

CARE Hospitals is seeking a senior leader to oversee Insurance Revenue & Volumes across units. The role focuses on coordinating with TPAs, insurers, and administrators to grow revenues from medical services.

You will lead a team, drive growth strategies, and ensure regulatory compliance in a matrix organization. The candidate should have 5+ years in a TPA leadership role, deep knowledge of healthcare insurance, and strong negotiation and leadership skills to optimize insurance-related processes

Qualifications

• Bachelor's degree in healthcare administration, business management, or related field.
• 5+ years of experience in a similar TPA leadership role within the hospital industry at Corporate/India level.
• Strong knowledge of healthcare insurance, claims processing, and reimbursement practices.

Responsibilities

• Develop and implement strategies for managing TPA operations.
• Oversee the TPA team and ensure adherence to quality standards and compliance.
• Monitor KPIs related to claims processing, turnaround time, accuracy, and customer satisfaction.
• Establish and maintain relationships with insurance companies, TPAs, and stakeholders.
• Lead a high-performing team and provide mentorship and training.

Skills

Leadership

Negotiation

Strategic planning

Stakeholder management

Team management

Education

Bachelor's degree in healthcare administration

Master's degree preferred

Tools

EMR systems

TPA platforms

Claims processing systems

Job description

Job Summary:

Candidate will be responsible for overseeing and managing the hospital's Insurance Revenue & Volumes for all CARE Hospitals Units. This role involves coordinating with insurance companies, managing relationships with third-party administrators, and ensuring the increase in Revenues with your contacts & relationships for medical services provided by the hospital. You will also be responsible for leading a team of professionals and implementing strategies to optimize Insurance Growth in a matrix organization.

Responsibilities:

• Insurance Growth Management:
  - Develop and implement effective strategies for managing TPA operations in line with the hospital's goals and objectives.
  - Ensure timely and accurate Growth strategies for wider reach and activities.
  - Oversee the TPA team and ensure adherence to quality standards, compliance regulations, and industry best practices.
  - Monitor key performance indicators (KPIs) related to claims processing, turnaround time, accuracy, and customer satisfaction.
  - Identify areas for process improvement, implement necessary changes, and monitor their effectiveness.
  - Find suitable opportunities to engage with Ins/TPA, Insuranance agents / faciliattors through various activities to grow the business


• Relationship Management:
  - Establish and maintain strong relationships with insurance companies, third-party administrators, and other stakeholders.
  - Collaborate with insurance providers to negotiate contracts, terms, and pricing agreements.
  - Resolve issues, disputes, and conflicts related to claims processing, billing, and reimbursement.
  - Conduct regular meetings and performance reviews with TPAs to evaluate their performance, address concerns, and identify areas for improvement.
  - Co-ordinate with all Units of Care and Ins/Corporate team , understand the challenges and resolve with timely intervention


• Team Leadership and Development:
  - Build and lead a high-performing team of TPA professionals, providing guidance, support, and mentorship.
  - Define team goals, objectives, and performance expectations aligned with the hospital's overall strategy.
  - Conduct regular training and development programs to enhance the team's knowledge and skills.
  - Foster a positive work environment that encourages collaboration, innovation, and continuous learning.


• Financial Analysis and Reporting:
  - Analyze financial data related to Insurance Growth.
  - Prepare monthly reports, forecasts, and budgets to monitor the financial performance of Insurance/TPA and team members (unit wise).
  - Identify cost-saving opportunities and implement strategies to optimize expenses without compromising quality or compliance.
  - Maintain trackers to ensure monitoring of renewals / expiry and timely negotiating for revision of rates


• Compliance and Regulatory Requirements:
  - Ensure compliance with applicable laws, regulations, and industry standards related to claims processing, privacy, and data security.
  - Stay updated with changes in healthcare regulations and insurance policies affecting TPA operations.
  - Implement processes and controls to maintain data accuracy, confidentiality, and integrity.

Requirements:

• Bachelor's degree in healthcare administration, business management, or a related field (Master's degree preferred).


• Proven experience (5 years or more ) in a similar TPA leadership role within the hospital industry at Corporate/India level


• In-depth knowledge of healthcare insurance, claims processing, and reimbursement practices. Established relationship with partners and stakeholders in the industry


• Familiarity with relevant laws, regulations, and industry standards.


• Strong leadership and team management skills with the ability to inspire and motivate a team.


• Excellent communication, NEGOTIATION, and interpersonal skills to build and maintain relationships with stakeholders.


• Analytical mindset with the ability to analyze financial data, identify trends, and make data-driven decisions.


• Can drive and contribute individually within a matrix organization , go getter and high on execution


• Proficiency in using healthcare software systems, electronic medical records (EMRs), and claims processing platforms.Role & responsibilities

Preferred candidate profile