Insurance Manager

The Insurance Manager is responsible for managing and overseeing the insurance empanelment process for the hospital, ensuring that the hospital is empaneled with all major insurance providers, TPAs (Third Party Administrators), and government health schemes. The role involves coordinating with insurance companies, government bodies, and healthcare providers to facilitate smooth and efficient insurance operations, ensuring that the hospital can offer insured patients access to timely and quality healthcare services. Key Responsibilities: 1. Insurance Empanelment: - Coordinate with insurance companies, third-party administrators (TPAs), and government health schemes (like CGHS, ESI, Ayushman Bharat) for empanelment of the hospital. - Prepare and submit necessary documentation and applications for empanelment with new insurance providers or networks. - Maintain up-to-date records of all empanelment agreements, ensuring compliance with contract terms and conditions. 2. Contract Negotiation and Management: - Negotiate insurance contracts and rates with insurance providers and TPAs. - Review and assess existing agreements to ensure favorable terms for the hospital. - Monitor renewal dates and ensure timely renewal of empanelment agreements. 3. Claims Management and Dispute Resolution: - Work closely with the billing and finance team to facilitate smooth claims submission, follow-ups, and resolution of any insurance-related queries or issues. - Act as a liaison between the hospital, insurance companies, and patients to resolve claim disputes and discrepancies. - Ensure timely reimbursement of claims and investigate any delays or non-payment issues. 4. Relationship Management: - Build and maintain strong relationships with insurance providers, TPAs, government agencies, and other stakeholders. - Serve as the primary point of contact for all insurance-related inquiries, issues, and communications from insurance companies or third parties. Skills and Qualifications: - Bachelor’s or Master’s degree in Healthcare Management, Insurance, Business Administration, or a related field. - Certifications in Insurance or Health Administration (e.g., LOMA, AIC, etc.) would be a plus. Experience: - Minimum of 2-3 years of experience in insurance empanelment, healthcare administration, or a related field in a hospital or healthcare setting. - Proven experience in negotiating insurance contracts and managing relations with insurance companies, TPAs, and government schemes. Knowledge: - In-depth understanding of insurance policies, health insurance schemes (both private and government), and hospital billing practices. - Knowledge of relevant regulations, such as the Insurance Regulatory and Development Authority of India (IRDAI) guidelines, government health programs, and hospital accreditation standards.