AM/DM(Health Insurance Administration & Receivables)Sales & Marketing

AM/DM Health Insurance Administration & Receivables (Sales & Marketing)

Location:

Job Purpose

The incumbent will manage TPA collections and deduction recoveries, maintain strong relationships with TPAs and insurers, and ensure timely reconciliation of receivables while driving process improvements and reducing deductions.

Key Responsibilities

• Collections Targets Achievement.
• Deductions Recovery Targets Achievement
• Core Outstanding & Deduction outstanding reconciliation
• Prepare and regularly update Outstanding/ Deduction Trackers.
• Coordination & hold regular meetings with dispatch teams to ensure timely submission of TPA credit bill dockets within defined TAT
• Analyse deduction trends and provide actionable insights
• Develop and implement strategies to minimize deductions and improve recovery
• Prepare Periodical reports on Outstanding & deduction metrics including receivable status, Aging analysis, deduction trends, deduction recovery performance
• Identifying Process gaps and recommend improvements
• Build and maintain strong, long-term relationships with TPA/ Insurer relationships by partnering with them and understanding their needs
• Handel External & Internal Grievance Management
• Manage New TPA Empanelment and Renewals of existing Service agreements.
• Cashless related Issues Troubleshooting
• Coordinate with Pricing Cell and IP Billing departments to resolve billing related grievances
• Point of contact as escalation point for TPA/ Insurance Network teams to address day-to-day issues.

Key Performance Indicators

• Achievement of

  deduction and recovery targets

  .
• Effective

  deduction trend analysis

  and actionable implementation.
• Reduction in overall

  deduction percentage

  .
• Strong

  relationship management

  and grievance resolution efficiency.

Skills & Competencies

Behavioral Skills:

• Strong interpersonal and communication skills
• Initiative and adaptability
• Relationship management mindset
• Performance-oriented attitude
  

Technical Skills:

• Proficient in Healthcare Billing & Credit Billing
• Excellent knowledge of HIS (Hospital Information System)
• Strong command of MS Excel, Word, and PowerPoint
• Analytical and reporting skills
  

Regards,

Sujeet Sinha