Senior Manager Insurance

As an Insurance Operations Manager, you will be responsible for overseeing end-to-end insurance operations, including claims submission, follow-ups, denials management, and reimbursements. Your key responsibilities will include: - Leading and managing the Accounts Receivable (AR) team to ensure timely collection and reconciliation of dues. - Monitoring KPIs such as DSO (Days Sales Outstanding), denial rates, claim rejection ratios, etc. - Travelling regularly to insurers and TPAs to reconcile outstanding claims and bring about closure of long-pending cases. - Thoroughly analyzing disallowances, providing reasoned justifications, and apprising the Group Head of the recoverable and non-recoverable amounts. - Reviewing, interpreting, and comparing tariffs and packages across insurance partners. Collaborating with department HODs to determine appropriate pricing for services and procedures. - Conducting market intelligence to gather comparative pricing insights for procedures and treatments to support strategic pricing decisions. - Developing and enforcing policies and procedures to improve operational efficiency and compliance with healthcare regulations. - Collaborating with internal stakeholders (billing, clinical, legal teams) to resolve claim-related disputes or bottlenecks. - Conducting regular audits of claim and AR processes to identify revenue leakage or compliance risks. - Training, mentoring, and evaluating team members to ensure consistent performance and growth. - Preparing and presenting monthly and quarterly reports to senior leadership on AR aging, collections, and outstanding claims. Qualifications Required: - Bachelor's or Master's Degree in Dental Science, Medicine, Commerce, Finance, Healthcare Administration, or related field. - Strong analytical and negotiation skills, especially in resolving claim disputes and interpreting disallowances. - Excellent leadership, analytical, and communication skills. - Proficiency in using hospital management systems (HIS), ERP tools, and Excel-based dashboards.,