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 solid 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

📌 General Manager Insurance (Chennai)
🏢 Dr.Kamakshi Memorial Hospital
📍 Chennai