Senior Manager - TPA Management

Location: Bangalore

Role: Senior Manager TPA Management

Job Summary

Accountable for performance, governance, and operational excellence across external TPAs. Ensures strong service delivery, compliance, timely issue resolution, and continuous improvement in claims operations through effective crossfunctional collaboration, analytics, and team leadership.

Key Responsibilities

1. TPA Performance Governance

• Lead TPA performance reviews and ensure adherence to SLAs.
• Maintain governance through regular reviews, dashboards, and escalations.
• Drive corrective actions for performance gaps.

2. TAT, Quality & Compliance

• Ensure claims handled by TPAs meet TAT and quality standards.
• Monitor SOP, audit, and regulatory compliance.
• Improve processes for better accuracy and efficiency.

3. Process & Issue Management

• Identify process/technical gaps and drive long-term fixes.
• Collaborate with internal teams to resolve recurring issues.
• Lead root-cause analysis and implement sustainable solutions.

4. Cross-Functional Alignment

• Act as key liaison between Digit teams and TPAs.
• Align TPA operations with business priorities and system/product changes.
• Ensure seamless coordination during launches and updates.

5. Analytics & Reporting

• Oversee MIS on TPA performance, TAT, productivity, leakage, and quality.
• Provide insights through data analysis and dashboards.
• Present actionable recommendations to leadership.

6. People Management

• Lead and mentor the TPA operations team.
• Build team capability and ensure clarity of goals.
• Foster a culture of ownership and continuous improvement.

Experience Required

• 8-10 years of experience in Claims Operations / TPA Management / Health Insurance ecosystems.
• Minimum 3+ years of experience in managing external vendor operations or claims governance.

Technical Skills

Advanced proficiency in:

• Excel (dashboards, power analysis)
• Power Query
• SQL (for analytics and deep dives)
• VBA (preferred)
• Strong understanding of claims processes, health insurance workflows, regulatory norms, and TPA functioning.
• Ability to work closely with technology/product teams on system enhancements.