Senior Manager – Insurance

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 :