TPA Manager – Health Insurance Claims

About the role

The TPA Manager will lead the relationship with the Third‑Party Administrator responsible for health insurance claims, ensuring efficient processing, regulatory compliance and a superior customer experience. This role is central to the company’s strategy to become the preferred health‑insurance provider in the Philippines.

Key responsibilities

• Support and execute TPA strategies aligned with business objectives.
• Drive transformation initiatives to improve the customer experience within the TPA scope.
• Define, monitor and report KPIs and SLAs such as TAT, complaint handling, FCR, NPS and fraud metrics.
• Manage day‑to‑day TPA operations for claims and contact centre, acting as primary escalation point.
• Review and report financial and non‑financial errors weekly and monthly with the Health Claims Team.
• Facilitate monthly TPA Steering Committee meetings to identify challenges and propose solutions.
• Assist in building an in‑house provider network, including recruitment, credentialing and contracting.
• Establish quality‑assurance processes, analyse feedback and implement automation and technology improvements.
• Lead internal staff supporting TPA operations, providing training on claims and vendor‑management processes.
• Manage the revolving fund, billing, reconciliation of paid claims and TPA fees, and monitor budget adherence.
• Ensure compliance with internal policies, external regulations and manage fraud and regulatory risk.

Required profile

• Proven experience managing TPA relationships and health‑insurance claims processing.
• Strong knowledge of regulatory compliance, risk and fraud management.
• Leadership experience overseeing cross‑functional teams and driving continuous improvement.
• Ability to develop, monitor and report on KPIs, SLAs and financial performance.
• Experience with budgeting, cost‑efficiency monitoring and provider‑network development.

Required skills