<ul><li>Oversee and manage the day-to-day operations of the Third-Party Administrator (TPA) services, ensuring smooth processing of claims and services.</li><li>Coordinate with insurance companies, healthcare providers, and clients to ensure efficient claims management and approval.</li><li>Ensure that all claims are processed in compliance with the relevant policies, procedures, and regulatory requirements.</li><li>Review and verify claim documents and medical records for accuracy, completeness, and eligibility before processing.</li><li>Handle escalated customer inquiries, complaints, and disputes related to claims, providing resolutions in a timely and professional manner.</li><li>Liaise with healthcare providers to negotiate and maintain service agreements, ensuring cost-effective healthcare delivery.</li><li>Manage and supervise the TPA team, providing training, support, and guidance to ensure high-quality service delivery.</li><li>Prepare and analyze reports on claims processing, trends, and performance metrics to improve operational efficiency.</li><li>Work closely with the finance department to ensure timely and accurate payments and settlements of claims.</li></ul>

TPA Manager