FULLTIME

General Manager - Insurance

DR.KAMAKSHI MEMORIAL HOSPITAL PVT. LTD., (Inst. Code - 381) CHENNAI

Not specified · onsite · Posted 9d ago

Sourced from Foundit

Not disclosed15–17 yrsfulltimeNot specified

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Section · 01

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General Manager - Insurance

Job Description

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

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Section · 02

Skills

Healthcare insurance managementInsurance TPA empanelmentTariff negotiationsRevenue Cycle ManagementHospital Information Systemscontract managementMISMS Office

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