Walk-in | Tpa Manager/executive/govt panel

Nks Hospital; New Delhi; On-site; INR 900,000 - 1,300,000; Full time

Job summary

Nks Hospital invites applications for the role of TPA Manager / Executive. You will oversee end-to-end TPA and insurance claim processes, coordinating with TPAs, insurers, corporate clients and patients for cashless and reimbursement cases.

The role requires strong knowledge of pre-authorisation, claim submission, settlements and cross-department collaboration, ensuring timely and accurate documentation.

Qualifications

• Experience in hospital TPA/insurance/cashless operations.
• Good knowledge of major TPAs, insurance processes, pre-authorisation, claim submission & settlement.
• Strong communication, coordination, documentation and follow-up skills.

Responsibilities

• Manage end-to-end TPA and insurance claim processes from patient admission to final settlement.
• Coordinate with TPAs, insurance companies, corporate clients and patients for cashless and reimbursement cases.
• Handle pre-authorisation, enhancement requests, discharge approvals and final settlement.

Skills

Communication

Coordination

Documentation

Follow-up

Team leadership

Education

Graduate/MBA/Master in Hospital Administration

Tools

MS Excel

TPA software

Job description

TPA Manager / Executive Roles & Responsibilities

Role: TPA Manager / Executive/govt panel

Department: TPA / Insurance & Billing

Industry: Hospital / Healthcare

Key Responsibilities:

• Manage end-to-end TPA and insurance claim processes, from patient admission to final claim settlement.
• Coordinate with TPAs, insurance companies, corporate clients, and patients for cashless and reimbursement cases.
• Handle pre-authorisation, enhancement requests, discharge approvals, and final settlement.
• Ensure timely submission of complete and accurate claim documents to avoid delays and rejections.
• Verify patient eligibility, policy coverage, approvals, and applicable deductions.
• Coordinate with billing, medical, nursing, MRD, and other hospital departments for required documents.
• Monitor pending claims, query cases, deductions, rejections, and claim outstanding.
• Resolve discrepancies and follow up with TPAs/insurers for timely settlement.
• Maintain proper TPA records, MIS reports, trackers, and documentation.
• Ensure compliance with hospital policies, insurance guidelines, and applicable regulatory requirements.
• Supervise and guide TPA executives/team members, if handling a managerial position.
• Analyze claim rejection/deduction trends and take corrective actions to improve collection and reduce revenue leakage.
• Maintain professional communication with patients and their attendants regarding insurance-related processes.

Preferred Candidate Profile:

• Graduate / MBA / PG in Hospital Administration, Healthcare Management, or related field preferred.
• Experience in hospital TPA/insurance/cashless operations.
• Good knowledge of major TPAs, insurance processes, pre-authorisation, claim submission, and settlement.
• Strong communication, coordination, documentation, and follow-up skills.
• Proficiency in MS Excel and hospital/TPA software preferred.
• For Manager: Prior experience in team handling and TPA department management is preferred.