Manager - TPA

JOB DESCRIPTION

Manager (TPA) Front Office

MAX OVERVIEW:

Max Healthcare Institute Limited (MHIL), founded in 2000, is one of Indias largest private hospital chain with 22+ healthcare facilities. Being the India's most valuable listed healthcare organisations, we have driven innovation and excellence in healthcare for 25 years. With a workforce of 35,000+, including 5,000+ clinicians and 12,000 nurses/paramedics, we deliver advanced care across key locations including Delhi NCR (Saket, Patparganj, Vaishali, Rajendra Place, Shalimar Bagh, Dwarka, Gurugram, Panchsheel Park, Noida, Lajpat Nagar, Bulandshahr), Mumbai, Mohali, Bathinda, Dehradun, Lucknow, and Nagpur.

We also operate Max@Homeamong Indias largest healthcare-at-home services in 12 citiesand Max Lab, offering 2,700+ tests in 50+ cities across North India.

Roel overview:

Responsible for overseeing insurance claim processing within the hospital, ensuring accurate medical documentation, timely approvals, and smooth coordination with Third Party Administrators (TPAs) and insurance companies. The role requires clinical expertise (MBBS) to validate treatments, justify procedures, and prevent claim rejections

ROLES AND RESPONSIBILITIES:

Insurance Claim Handling

• Process cashless and reimbursement claims
• Coordinate with TPAs
• Ensure pre-authorization approvals

Documentation & Compliance

• Verify patient records, discharge summaries
• Ensure ICD coding accuracy
• Maintain claim records

Coordination

• Work with insurance desk, billing, doctors, and nursing staff
• Resolve claim queries and rejections

Denial & Rejection Management

• Handle claim rejections
• Follow up for settlements
• Reduce TAT (Turnaround Time)

Team Supervision

• Manage TPA desk executives
• Train staff on updated insurance policies
• To be well groomed, punctual & adhere to company policies and practices.

Years of Experience:

• 08-10 years of healthcare experience in the relevant work.

Qualifications:

• MBBS/BDS/BHMS/BPT Preferably with PG Diploma in Hospital Management.

Any Other Specification: