General Manager - Insurance

Dr. Kamakshi Memorial Hospital Pvt Ltd; Chennai; On-site; INR 2,200,000 - 4,200,000; Full time

Job summary

Dr. Kamakshi Memorial Hospital Pvt Ltd in Chennai is seeking a senior leader to manage day-to-day Insurance, TPA, Corporate and Credit Desk operations and provide strategic direction for revenue-cycle management across all hospital branches.

The role requires 15+ years in healthcare insurance or revenue cycle management, with strong leadership, negotiation and analytical skills and a proven track record in contract management and tariff negotiations.

Qualifications

• 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

Responsibilities

• 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 strong 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.

Skills

Leadership

Negotiation

Stakeholder management

Analytical thinking

MS Office

MIS

Hospital information systems

Education

Any Degree Holder (UG/PG Arts & Science)

Tools

MS Office

MIS

Hospital information systems

Job description

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 strong 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 satisfactionBranch-wise revenue-cycle performance
• Team productivity and process compliance