- Location
- Sholinganallur, Tamil Nadu, India
- Job type
- Full-time
Required skills
- client satisfaction
- compliance
- contract management
- end-to-end
About the role
DR.KAMAKSHI MEMORIAL HOSPITAL PVT. LTD., (Inst. Code - 381) CHENNAI
Website:
drkmh.com
Job details:
Home| Careers| Job opening
We Hire
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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