Cashless Manager

HealthIndia Insurance TPA Services

3 - 5 years

4 - 6 Lacs

mumbai

Posted:2 days ago| Platform:

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Skills Required

tpa managerial skills cashless health insurance

Work Mode

Work from Office

Job Type

Full Time

Job Description

Role Overview:

The Manager will be responsible for supervising and coordinating the day-to-day operations of the Cashless Department, ensuring timely pre-authorization processing, adherence to SOPs/SLAs, compliance with IRDAI guidelines, and smooth communication with insurers, hospitals, and internal teams.

Key Responsibilities:

Manage daily cashless authorization workflow and ensure TAT compliance.
Review and approve high-value or complex pre-authorization cases.
Ensure adherence to insurer guidelines, SOPs, and IRDAI regulations.
Handle escalations from hospitals, insurers, and brokers.
Monitor team performance, allocate workloads, and conduct training.
Coordinate with Provider Network, Claims, and Investigation teams for flagged or special cases.
Maintain MIS and reporting for management and insurers.

Key Performance Indicators (KPIs):

% of pre-auth requests processed within SLA/TAT.
Compliance and audit scores (internal/insurer/IRDAI).
Escalation resolution rate and stakeholder satisfaction.
Accuracy and error rate in approvals.
Team productivity and adherence to shifts.

Qualifications & Experience:

MBBS / BAMS / BHMS / TPA/ Insurance background preferred.
6 - 10 years of experience in cashless/claims operations in TPA or health insurance, with at least 2-3 years in a supervisory role.
Strong knowledge of medical protocols, insurer guidelines, and provider network management.
Good leadership, communication, and problem-solving skills.

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