Walk-in | TPA Head

Sewa Sadan Eye Hospital Trust; Bhopal; Sur place; INR 1 600 000 - 2 400 000; Plein temps

Résumé du poste

Sewa Sadan Eye Hospital Trust in Bhopal is seeking a seasoned TPA Head to oversee insurance and empanelment operations, ensuring smooth claims processing, strong partnerships with TPAs and insurers, and growth of the empaneled network.

The role requires strategic planning, compliance oversight and team leadership to strengthen insurance-related operations and service quality across the hospital, with a focus on pre-authorization, cashless claims, contract renewals and timely MIS reporting.

Qualifications

• 5 to 10 years in TPA operations, health insurance or hospital empanelment, including 3+ years in a managerial role.
• Male candidate preferred.
• Strong understanding of health insurance products, claims workflows, tariffs and hospital billing.
• Excellent communication, negotiation and analytical skills.
• Proficient in MS Office (Excel) and hospital management systems (HMS/HIS).

Responsabilités

• Lead and manage TPA operations to ensure timely and accurate pre-authorization, cashless and reimbursement claim processing.
• Drive empanelment with insurance companies, TPAs, corporates and government health schemes (e.g., Ayushman Bharat PM-JAY, CGHS, ECHS, state schemes).
• Oversee contract renewals, tariff negotiations and compliance with empanelment terms.
• Build and maintain strong relationships with insurers, TPAs, corporate clients and other key stakeholders.
• Monitor claim rejections, deductions and outstanding receivables; implement corrective action to improve settlement ratios and reduce TAT.
• Provide strategic reports, MIS and insights to senior management.
• Handle and resolve escalated patient, insurer or TPA-related issues.
• Ensure compliance with IRDAI guidelines, scheme norms and audit requirements.
• Recruit, train and lead the insurance desk, billing coordinators and TPA/claims team.
• Drive process improvement and coordination between clinical, billing, finance and front-office teams.

Connaissances

TPA operations

Health insurance

Leadership / managerial experience

Contract negotiations

Communication skills

MS Office Excel

Formation

Bachelor's or Master's in Healthcare Administration/Business Management

MBA/PGDM preferred

Outils

MS Office

Hospital Management Systems (HMS/HIS)

Description du poste

The TPA Head will oversee all insurance and empanelment operations of the hospital, ensuring efficient claims processing, strong partnerships with TPAs and insurers, and steady growth of the hospitals empaneled network. The role combines strategic planning, compliance oversight and team leadership to strengthen insurance-related operations and service quality.

Key Responsibilities

• Lead and manage TPA operations to ensure timely and accurate pre-authorization, cashless and reimbursement claim processing.
• Drive empanelment with insurance companies, TPAs, corporates and government health schemes (e.g., Ayushman Bharat PM-JAY, CGHS, ECHS, state schemes).
• Oversee contract renewals, tariff negotiations and compliance with empanelment terms.
• Build and maintain strong relationships with insurers, TPAs, corporate clients and other key stakeholders.
• Monitor claim rejections, deductions and outstanding receivables; implement corrective action to improve settlement ratios and reduce TAT.
• Provide strategic reports, MIS and insights to senior management.
• Handle and resolve escalated patient, insurer or TPA-related issues.
• Ensure compliance with IRDAI guidelines, scheme norms and audit requirements.
• Recruit, train and lead the insurance desk, billing coordinators and TPA/claims team.
• Drive process improvement and coordination between clinical, billing, finance and front-office teams.

Requirements

• Qualification: Bachelors or Master’s degree in Healthcare Administration, Business Management or a related field. MBA/PGDM (Hospital/Healthcare Management) preferred.
• Experience: 5 to 10 years in TPA operations, health insurance or hospital empanelment, including 3+ years in a managerial role.
• Male candidate preffered.
• Strong understanding of health insurance products, claims workflows, tariffs and hospital billing.
• Excellent communication, negotiation and analytical skills.
• Proficient in MS Office (especially Excel) and hospital management systems (HMS/HIS)