We are looking for an Operations Manager We are looking for an Operations Manager to manage and oversee end-to-end operational functions including enrollment, claims, customer service, insurer coordination, and compliance. The role requires a strong hands-on manager with deep operational knowledge, process discipline, and the ability to lead teams while ensuring SLA adherence and regulatory compliance.
Key Roles & ResponsibilitiesOperational Management
- Define, implement, and monitor Standard Operating Procedures (SOPs) for core operations including enrollment, claims, and customer service.
- Oversee onboarding and integration of new insurers, ensuring compliance with service-level commitments and data requirements.
- Act as the single point of contact (SPOC) for insurers and regulatory bodies for operational escalations, audits, and process clarifications.
Process & Performance Management
- Ensure error-free policy and member enrollment in line with insurer SLAs.
- Drive end-to-end claims operations, ensuring adherence to TAT and quality benchmarks.
- Monitor service delivery metrics, identify gaps, and implement corrective actions.
- Implement continuous process improvement initiatives to enhance turnaround time, service quality, and cost efficiency.
Technology & Automation
- Coordinate with IT for system enhancements, claims automation, and insurer-specific integrations.
- Track technology deliverables including UAT, validations, and production rollouts.
- Promote data-driven decision-making through MIS, dashboards, and operational analytics.
People Management & Training
- Lead, mentor, and manage multi-functional operational teams across enrollment, claims, and customer service.
- Ensure optimal manpower utilization and productivity.
- Establish and implement training frameworks (process, system, and functional) for new hires and existing employees.
- Foster a performance-driven culture emphasizing accountability, teamwork, and continuous learning.
Customer & Stakeholder Management
- Oversee CRM and contact center operations, ensuring timely resolution of customer and corporate client queries.
- Ensure effective coordination with insurers, hospitals, and internal departments for policy issuance, endorsements, and claims settlement.
- Maintain strong stakeholder communication to align operational delivery with business objectives and customer expectations.
Governance & Compliance
- Ensure strict adherence to IRDAI guidelines, internal policies, and audit requirements across operational areas.
- Coordinate with Finance for claims payment flow, reconciliation, and timely insurer settlements.
- Implement risk management controls and compliance checks to safeguard data integrity and operational transparency.
Outcome Expectations
- Achieve 100% SLA compliance across enrollment and claims operations.
- Maintain high customer satisfaction levels (CSAT/NPS) through proactive service delivery.
- Support operational improvements focused on efficiency, accuracy, and scalability.
- Contribute to cost optimization through streamlined operations and improved controls.
Qualification & Experience
- Graduate in any discipline (Master’s degree preferred).
- 10–15 years of experience in Health Insurance / TPA operations, with strong exposure to claims and enrollment management.
- Proven experience in managing teams, insurer coordination, and compliance requirements.
Core Competencies
- Strong knowledge of health insurance products, policy terms, and operational workflows
- Hands-on experience in TPA operations, claims administration, and hospital network coordination
- Good understanding of IRDAI regulations and audit processes
- Experience with enrollment portals, claims systems, CRM, and MIS tools
- Strong people management, problem-solving, and communication skills
- Interested candidate can share your updated CV to hr@linkktpa.com
Job Types: Full-time, Permanent
Pay: ₹35,000.00 - ₹45,000.00 per month
Benefits:
- Cell phone reimbursement
- Flexible schedule
- Paid time off
- Provident Fund
Work Location: In person
