Key Responsibilities

1) Empanelment, MoU Closure & Relationship Management

· Identify, onboard, and expand payer coverage across AB-PMJAY, TPAs, insurers, and corporates via MoUs/Service Line Agreements (SLAs).

· Lead end-to-end agreement lifecycle: proposal, negotiation, documentation, approval, renewal, and exit (if required).

· Work with the Legal team to draft/review/close MoUs and ensure operational clauses are implementable.

· Maintain strategic relationships with payer decision-makers; conduct periodic reviews to improve volumes and settlement timelines.

· Build relationships where there is potential for high business

2) Process Design, SOPs & Compliance to MoUs

· Convert each MoU into clear internal SOPs (patient journey, documentation checklist, approvals, portal steps, billing rules, timelines).

· Ensure MoU compliance across departments; monitor deviations and fix root causes through training and corrective actions.

· Develop a system of continuous excellence and SOP revisions where appropriate

· Standardize package definitions, inclusions/exclusions and documentation requirements (scheme-wise/payer-wise).

3) Patient Guidance & Front-End Facilitation

· Ensure patient-facing teams are provided accurate guidance on eligibility, documentation, pre-authorisation, and the cashless process, and implement clear SOPs aligned to signed MoUs/SLAs to strengthen process discipline and robustness.

· Resolve escalations related to approvals/denials/eligibility/portal errors, while protecting patient experience and hospital ethics.

4) Portal Operations & Cashless Execution Discipline

· Ensure all relevant staff are trained and proficient in using payer portals (AB-PMJAY/TPA/insurer portals) by establishing a standard induction programme, which can also be used for onboarding and training F2E girls.

· Drive excellence in pre-authorisation submissions, timely bill uploads, query management, and end-to-end claim tracking till closure by creating and enforcing clear checklists and step-by-step process documentation for each payer/workflow.

· Build checklists, maker–checker controls, and daily trackers to ensure zero slippage.





· Build and lead a high-performing payer management team (empanelment, portals, documentation, query desk).

5) Claims, Receivables & Realization (Revenue Integrity)

· Ensure timely submission of service bills and supporting documents; reduce rejections and avoidable deductions.

· Own claim follow-up rhythm and coordinate with Finance & Accounts for receipts, reconciliations, and ageing control.

· Establish dashboards for claim status, pending queries, ageing, and payer-wise performance.

· Ensure all relevant staff are trained and proficient in using payer portals (AB-PMJAY/TPA/insurer portals) through a standardised induction program (reusable for onboarding/training F2E girls), with periodic refresher sessions and competency checks.

· Drive excellence in pre-authorisation submissions, timely bill uploads, query management, and end-to-end claim tracking till closure by developing payer-wise checklists and step-by-step SOPs and ensuring strict adherence through maker–checker controls.

· For every major denial, deduction, portal failure, or incident/escalation, document the resolution method and learnings and share the same with the Knowledge Management (KM) vertical for institutional use (case logs/playbooks).

· Update SOPs based on learnings from claims/queries/incidents to prevent repeat errors, improve first time-right submissions, and strengthen process robustness across teams.

· Embed risk-averse insurance management practices by ensuring strong compliance to MoUs/SLAs, documentation discipline, data privacy controls, audit readiness, and proactive escalation of any potential non-compliance, fraud risk, or recurring rejection patterns.

6) Training and Culture Building

· Create a training calendar and competency checks for staff handling portals, documentation,



and payer SOPs.

· Identify high-potential Football to Eyeball (F2E) girls suited for payer/portal operations, and train and mentor them within this framework—developing at least 6 F2E women into supervisory/leadership roles as per the leadership plan.

Outcome: Strong culture of accountability, responsiveness and closure discipline.

· Values (Non-Negotiables): Adhering to Akhand Jyoti’s Value Compass of : Compassion, Commitment, Teamwork and Respect

· Leading from the Back (expected leadership behaviors, non-negotiable):

Self Leadership:

Ø Open-mindedness: listen first; welcome data and frontline inputs before decisions.

Ø Ownership: take end-to-end responsibility; no handover culture.

Ø Detachment: remain objective; solve problems without ego or blame.

Team Leadership:

Ø Trust: build trust through transparency, predictability, and fairness.

Ø Leverage strengths: place people where they perform best; develop capability intentionally.

Ø Collaboration: break silos; ensure payer workflows align with clinical operations and patient experience.

Task Leadership:

Ø Outside-in thinking: understand payer expectations, patient constraints, and compliance realities; design accordingly. Identifying other potential customers, benchmark with other best in class hospitals.

Ø Test the limits (safely): improve speed and efficiency without compromising ethics, safety, accuracy, quality or compliance.

Ø Be tough softly: firm on standards and timelines; respectful in communication.

8) Governance, Committees & Cross-Functional Collaboration

· Serve as an active member of committees as nominated (payer governance, revenue integrity, quality/patient experience, etc.).

· Work closely with clinical and operations teams to ensure payer workflows do not delay care delivery.

· Support organisational priorities/special assignments as mutually agreed or assigned by CGO/leadership, with explicit scope, timelines and reporting.

Job location will be in Mastichak, Parsa, Pojhi, Bihar-841219

Pay: ₹20,000.00 - ₹35,000.00 per month

Work Location: In person

📌 Insurance Liaison Officer & Payer Management (AB-PMJAY | TPAs | Corporates | Insurers) (Parsa)
🏢 AKHAND JYOTI EYE HOSPITAL
📍 Parsa