Senior Manager – Insurance

4 days ago

tamil nadu, India Kauvery Hospital Full time

Key Responsibilities:

  • Oversee end-to-end insurance operations including claims submission, follow-ups, denials management, and reimbursements.
  • Lead and manage the Accounts Receivable (AR) team to ensure timely collection and reconciliation of dues.
  • Monitor KPIs such as DSO (Days Sales Outstanding), denial rates, claim rejection ratios, etc.
  • Travel regularly to insurers and TPAs to reconcile outstanding claims and bring about closure of long-pending cases.
  • Thoroughly analyze disallowances, provide reasoned justifications, and apprise the Group Head of the recoverable and non-recoverable amounts.
  • Review, interpret, and compare tariffs and packages across insurance partners. Collaborate with department HODs to determine appropriate pricing for services and procedures.
  • Conduct market intelligence to gather comparative pricing insights for procedures and treatments to support strategic pricing decisions.
  • Build and maintain strong working relationships with insurance providers and third-party payers.
  • Develop and enforce policies and procedures to improve operational efficiency and compliance with healthcare regulations.
  • Collaborate with internal stakeholders (billing, clinical, legal teams) to resolve claim-related disputes or bottlenecks.
  • Conduct regular audits of claim and AR processes to identify revenue leakage or compliance risks.
  • Train, mentor, and evaluate team members to ensure consistent performance and growth.
  • Prepare and present monthly and quarterly reports to senior leadership on AR aging, collections, and outstanding claims.

Key Requirements:

  • Bachelor's or Master's Degree in Dental Science / Medicine / Commerce / Finance, Healthcare Administration, or related field.
  • Proven experience in managing AR and insurance functions in a healthcare setup or Proven experience in handling claims functions, billing and payment workflows within an Insurance set up.
  • Strong understanding of healthcare billing cycles, payer processes, and regulatory compliance (TPA, IRDAI guidelines, etc.).
  • Strong analytical and negotiation skills, especially in resolving claim disputes and interpreting disallowances.
  • Excellent leadership, analytical, and communication skills.
  • Proficiency in using hospital management systems (HIS), ERP tools, and Excel-based dashboards.

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