Head of Department - Cashless

HealthIndia Insurance TPA Services

10 - 15 years

6 - 8 Lacs

mumbai suburban

Posted:2 months ago| Platform:

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Skills Required

tpa managerial skills insurance team leadership health insurance

Work Mode

Work from Office

Job Type

Full Time

Job Description

Role Overview:

The Head of Cashless Department will be responsible for managing end-to-end cashless authorization services of the TPA, ensuring compliance with insurer SLAs and IRDAI guidelines, while driving operational efficiency, cost control, and customer satisfaction.

Key Responsibilities:

Lead and manage the cashless operations team across regions.
Ensure timely pre-authorization approvals within insurer SLAs.
Maintain compliance with IRDAI regulations and internal SOPs.
Coordinate with insurers, providers, and brokers for escalations and special approvals.
Monitor high-value claims, deviations, and potential fraud risks.
Drive process improvements, automation, and MIS reporting.
Train, mentor, and manage team performance.
Fraud Hospital Indicator on basis of claim trend analysis and recommendation to provider department
To meet all TAT for Initial and Final as per the set by the regulator, if not ability to justify with RCA and implementation of corrective measures.

Key Performance Indicators (KPIs):

Turnaround Time (TAT) for pre-auth approvals.
Compliance and audit scores (IRDAI/insurer).
% of leakage/penalty cases avoided.
Stakeholder satisfaction (insurers, hospitals, brokers).
Team productivity and attrition rate.

Qualifications & Experience:

MBBS / BAMS / BHMS with Health Insurance/TPA background preferred.
1015 years of experience in cashless/claims operations in TPA or health insurance.
Strong leadership, process management, and stakeholder coordination skills.

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