Key Skills

- Strong knowledge of TPA and health insurance processes

- Cashless authorization and claim management

- Knowledge of pre-authorization, discharge approval, and reimbursement claims

- Coordination with Insurance Companies and TPAs

- Hospital billing and insurance documentation

- Team handling and people management

- Strong communication and interpersonal skills

- Problem-solving and escalation management

- Negotiation and stakeholder management

- Knowledge of healthcare/insurance regulations and SOPs

- MIS, reporting, and data analysis

- Positive working knowledge of MS Excel, Word, and PowerPoint

- Ability to work under pressure and meet timelines

Key Job Responsibilities

1. TPA & Insurance Operations

- Manage day-to-day TPA and insurance-related activities.

- Coordinate with TPAs and insurance companies for cashless approvals and claim processing.

- Monitor pre-authorization, enhancement requests, discharge approvals, and final settlements.

- Ensure timely submission and processing of required documents.

1. Claims Management

- Monitor cashless and reimbursement claims.

- Identify discrepancies, documentation gaps, and claim-related issues.

- Coordinate with billing, medical, nursing, and other departments for claim resolution.

- Follow up on pending and rejected claims and ensure timely closure.

1. Stakeholder Coordination

- Maintain effective relationships with TPAs, insurance companies, patients, doctors, and hospital departments.

- Handle escalations related to approvals, deductions, claim settlement, and billing.





- Ensure timely communication and resolution of stakeholder concerns.

1. Team Management

- Supervise and guide the TPA/insurance team.

- Allocate work and monitor team performance.

- Conduct regular reviews and provide guidance/training to team members.

- Ensure adherence to departmental SOPs and turnaround times (TAT).

1. MIS & Reporting

- Prepare daily/weekly/monthly TPA and insurance reports.

- Monitor pending approvals, claims, deductions, rejections, and outstanding cases.

- Analyze operational data and identify areas for improvement.

- Present performance reports to management.

1. Compliance & Process Improvement

- Ensure compliance with hospital policies, insurance guidelines, and applicable regulatory requirements.

- Maintain proper documentation and records.

- Identify process gaps and implement corrective measures.

- Work toward improving TAT, claim realization, and patient satisfaction.

Key Performance Indicators (KPIs)

- Cashless approval TAT

- Claim settlement TAT

- Pending/rejected claim reduction

- Claim realization percentage

- Documentation accuracy

- Escalation resolution TAT

- Team productivity

- Patient/stakeholder satisfaction

- Compliance with SOPs

Preferred Candidate Profile The ideal candidate should have strong knowledge of healthcare insurance/TPA operations, excellent coordination skills, and the ability to manage a team and resolve complex claim-related issues. Candidates with BDS/BAMS and MBA/MHA qualifications and relevant healthcare/TPA experience will be preferred.

📌 Assistant Manager - Operations (New Delhi)
🏢 Aakash Health Care
📍 New Delhi