General Manager - Insurance

DR.KAMAKSHI MEMORIAL HOSPITAL PVT. LTD., (Inst. Code - 381) CHENNAI; Chennai District; On-site; INR 1,600,000 - 2,100,000; Full time

Job summary

DR.KAMAKSHI MEMORIAL HOSPITAL PVT. LTD. is seeking a senior leader in Chennai to drive insurance, TPA, corporate and credit operations across all branches, improving revenue-cycle performance.

The role demands 15+ years in healthcare insurance or revenue-cycle management, strong negotiation and analytical skills, and proven ability to manage complex vendor and client relationships within a hospital network.

Qualifications

• 15+ years experience in healthcare insurance management or revenue cycle management.
• Experience in Insurance/TPA empanelment, contract management and tariff negotiations.
• Degree holder (UG/PG Arts & Science) required.

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, 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.

Skills

Leadership

Negotiation

Analytical skills

Stakeholder management

Commercial awareness

Financial understanding

MS Office

Hospital information systems

Education

Any Degree (UG/PG Arts & Science)

Tools

MS Office

MIS

Hospital Information Systems

Job description

• 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
• 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
• Team productivity and process compliance