Assistant Manager - Operations

Aakash Health Care; New Delhi; On-site; INR 900,000 - 1,500,000; Full time

Job summary

Aakash Health Care in Delhi is seeking a skilled professional to lead TPA and health insurance operations, ensuring smooth cashless approvals, pre-authorization, and discharge processes.

The role requires coordinating with TPAs, managing claims, supervising a team, and delivering MIS reports while upholding SOPs and regulatory guidelines.

Qualifications

• Strong knowledge of healthcare insurance/TPA operations.
• Experience in cashless approvals and claim processing.
• Ability to manage a team and resolve complex claim issues.
• Experience with regulatory guidelines and SOPs.

Responsibilities

• Manage day-to-day TPA and insurance-related activities.
• Coordinate with TPAs and insurance for cashless approvals and claim processing.
• Monitor pre-authorization, enhancement requests, discharge approvals, and final settlements.
• Ensure timely submission and processing of required documents.
• Monitor cashless and reimbursement claims; identify discrepancies.
• Coordinate with billing, medical, nursing, and other departments for claim resolution.
• Follow up on pending and rejected claims and ensure timely closure.
• Maintain 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.
• Supervise and guide the TPA/insurance team.
• Allocate work and monitor team performance.
• Conduct regular reviews and provide training to team members.
• Ensure adherence to SOPs and turnaround times (TAT).
• 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.
• Ensure compliance with hospital policies, insurance guidelines, and regulatory requirements.
• Maintain proper documentation and records.
• Identify process gaps and implement corrective measures.
• Work toward improving TAT, claim realization, and patient satisfaction.

Skills

TPA processes

Health insurance

Cashless approvals

Pre-authorization

Discharge approvals

Reimbursement claims

TPA coordination

Hospital billing

Team management

Communication skills

Problem solving

Negotiation

Regulatory knowledge

MIS reporting

MS Excel

MS Word

PowerPoint

Time management

Tools

none

Job description

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
• Good 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.

2. 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.

3. 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.

4. 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).

5. 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.

6. 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.