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 :

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.