Job Description
Job Description – General Manager (Insurance)
Department: Insurance
Position Title: General Manager
Reports To: Director (F&A)
Responsible For: Insurance Coordination
Job Summary
The General Manager – Insurance is responsible for coordinating with insurance companies, corporate clients, and insured patients to ensure timely submission and settlement of insurance claims. The role requires maintaining compliance with Hospital policies, regulatory requirements, and Joint Commission International (JCIA) standards applicable to the department.
Key Duties and Responsibilities
Insurance Coordination & Collections
Coordinate with the Credit Collection Department to ensure effective realization of receivables from insurers and TPAs (Third-Party Administrators).
Work closely with the Rebilling Executive or TPA team to ensure all shortfalls and queries are resolved within a turnaround time (TAT) of 48 hours.
Respond to shortfalls and queries raised by TPAs within 24 hours and keep the Credit Collection Department informed for necessary follow-up actions.
Periodically monitor insurance outstanding balances and obtain reconciliation statements from the Credit Collection Department.
Review reconciliation statements and ensure claims are not pending due to missing documents or information from the Insurance Department.
Take appropriate measures to minimize or eliminate claim disallowances and maintain them at the lowest possible level.
Reporting & Monitoring
Provide regular MIS reports to the Head of Department (HOD) regarding insurance outstanding balances.
Submit action-taken reports on pending payments from an insurance department perspective.
Monitor and ensure rebilled claims are dispatched promptly and that no bill remains pending for more than 15 days.
Ensure invoices are received from Stores promptly and assist the Rebilling Executive in dispatching bills without delay.
Stakeholder Management
Undertake need-based visits to insurers and TPAs in coordination with the Credit Collection Department to resolve pending issues.
Maintain effective communication with insurance companies, corporate clients, and insured patients regarding claims and settlements.
Process Improvement & Training
Recommend and implement systems and process improvements to enhance claim realization in coordination with the HOD and Credit Collection Department.
Train hospital and college staff on insurance policies and procedures as requested by the HOD and through programs conducted by the Training Department.
Compliance & Quality
Participate in and contribute to quality improvement initiatives across the organization.
Adhere to Hospital rules, regulations, and established standards, including JCIA and NABH requirements.
Perform any other duties and responsibilities assigned by management within the scope of knowledge, skills, and experience.
Educational Qualification
Bachelor's Degree (Any Discipline)
Professional Experience
Minimum 10 years of experience in Healthcare Insurance and/or TPA operations.
Specialized Knowledge & Skills
Excellent communication and interpersonal skills.
Strong understanding of healthcare insurance processes and TPA operations.
Specialized training in the relevant area of expertise.
Ability to work collaboratively within teams.
Emotionally stable and in good physical health.
Working Hours / Shift
As per departmental on-call rotation and/or shift system, where applicable.Location
Kotturpuram, Chennai, Tamil Nadu, India 600085