Role Overview

The Candidate will be responsible for overseeing and monitoring end-to-end health insurance / TPA process & credit sales & Collection channel across Max Healthcare.

Key Roles and Responsibilities:
Responsible for TPA / Insurance Empanelment & renewals of contracts.
Responsible for periodical tariff revision & price negotiation with private & GIPSA insurance companies.
Responsible for timely recoveries of TPA Credit sales. (Collection & Deduction Recovery)
Liaoning with TPAs & Insurer key persons and relationship building.
Responsible for Rejection & Deduction follow ups.
Responsible for account reconciliation with internal & external customers.
Regular record updating of Insurance & Deduction Tracker
Periodic review of individual and departmental performance.
Defining the organizational goals, strategies, setting of internal monthly targets for collection & deductions.
Monitor, administer & training of the centralize team.
Regular visits & meeting with internal customers of the group such as TPA Desk, Finance & Accounts, Front Office,



and Bill Dispatch Departments;
ensuring smooth functioning of the TPA Process.
Performing troubleshooting during cashless approvals and pre & post-discharge of the patients for all units
Ensuring group’s timely dispatch of credit invoices for payment recoveries
Reconciling accounts with all TPAs, Insurance Companies, and internal Finance Teams
Directing on-account (NEFT) settlement for ensuring timely settlement of NEFT payments, creating departmental MIS, reports, and presentations pertaining to TPA revenue, debtors aging, collection, deduction, old payment & NEFT (on-account) settlement for periodic review of team with higher management
Following-up for deduction and rejection of the TPA claims;
reviewing & analysing Debtor Ageing and Daily Collection Reports
Monitoring day to day work of team on receivable software i.E., Eprapti.
To define and set the centralized TPA process.
Mot

📌 Health Insurance Operations Lead Noida
🏢 Max Healthcare
📍 Noida