General Manager Insurance

JOB SPECIFICATION:

• Any Degree Holder (UG/PG Arts & Science)
• A minimum of 15+ years of experience in healthcare insurance management or revenue cycle management.
• Proven experience in Insurance/TPA empanelment, contract management and tariff negotiations.
• Strong leadership, negotiation, analytical and stakeholder-management skills.
• Strong commercial and financial understanding.
• Proficiency in MS Office, MIS and hospital information systems. ROLES & RESPONSIBILITY:
• Manage day-to-day Insurance, TPA, Corporate and Credit Desk operations.
• Provide strategic and operational leadership for Insurance, TPA, Corporate, CGHS and Credit Operations across all hospital branches.
• Develop and implement strategies to improve revenue realization, collections and overall revenue-cycle performance.
• Lead end-to-end cashless operations, including pre-authorization, approvals, enhancements, discharge and claims processing.
• Manage relationships with Insurance Companies, TPAs, Corporate Clients, CGHS and other healthcare partners.
• Lead hospital empanelment, renewals, contract management and tariff negotiations.
• Negotiate and implement commercial terms and revised tariff structures with Insurance, TPA and Corporate clients.
• Oversee claim submission, settlement, denial management, deductions, disallowances and outstanding receivables.
• Monitor and improve claim turnaround time, collection performance and reduction of revenue leakage.
• Manage Corporate and Credit business, including credit limits, patient admissions, billing, collections and outstanding payments.
• Oversee CGHS operations and ensure compliance with applicable requirements.
• Develop strong professional relationships with consultants, corporate clients, insurance companies and TPAs.
• Monitor branch-wise operational and financial performance and ensure achievement of agreed targets.
• Identify process gaps and implement SOPs, automation and process improvements.
• Establish appropriate MIS, dashboards and performance-monitoring mechanisms for management review.
• Lead, mentor and develop the Insurance, TPA, Corporate, Credit and related teams across branches.
• Ensure compliance with insurance policies, contractual terms, hospital procedures and applicable regulations.
• Review and resolve critical patient grievances, claim escalations, show-cause notices and commercial disputes.
• Coordinate with Finance, Billing, Medical, Nursing, Operations and other departments to ensure seamless revenue-cycle operations.
• Conduct periodic performance reviews and take corrective actions wherever required.
• Present operational, financial and strategic reports to the CEO, Director and Chairman.
• Support senior management in business development, corporate tie-ups and revenue-enhancement initiatives.
• Undertake other strategic responsibilities assigned by Management.

Key Performance Areas (KPIs)

• Insurance & TPA revenue realization
• Corporate business growth
• Claim settlement and collection performance
• Reduction in claim denials and deductions
• Reduction in outstanding receivables
• Cashless/pre-authorization turnaround time
• Empanelment and contract renewals
• Tariff negotiation and commercial optimization
• Credit-limit and outstanding control
• CGHS operational performance
• Patient and corporate client satisfaction
• Branch-wise revenue-cycle performance

Team productivity and process compliance