CARE Hospitals - Head - TPA/Insurance

Job Summary:

As the Insurance Vertical Head in the hospital industry, you will be responsible for overseeing and managing the hospital's Insurance Revenue & Volumes for all CARE Hospitals Units. Your role will involve coordinating with insurance companies, managing relationships with third-party administrators, and ensuring the increase in Revenues with your contacts & relationships for medical services provided by the hospital. You will also be responsible for leading a team of professionals and implementing strategies to optimize Insurance Growth in a matrix organization.

Responsibilities:

1. Insurance Growth Management:

- Develop and implement effective strategies for managing TPA operations in line with the hospital's goals and objectives.

- Ensure timely and accurate Growth strategies for wider reach and activities.

- Oversee the TPA team and ensure adherence to quality standards, compliance regulations, and industry best practices.

- Monitor key performance indicators (KPIs) related to claims processing, turnaround time, accuracy, and customer satisfaction.

- Identify areas for process improvement, implement necessary changes, and monitor their effectiveness.

- Find suitable opportunities to engage with Ins/TPA, Insuranance agents / faciliattors through various activities to grow the business

2. Relationship Management:

- Establish and maintain strong relationships with insurance companies, third-party administrators, and other stakeholders.

- Collaborate with insurance providers to negotiate contracts, terms, and pricing agreements.

- Resolve issues, disputes, and conflicts related to claims processing, billing, and reimbursement.

- Conduct regular meetings and performance reviews with TPAs to evaluate their performance, address concerns, and identify areas for improvement.

- Co-ordinate with all Units of Care and Ins/Corporate team , understand the challenges and resolve with timely interventi

3. Team Leadership and Development:

- Build and lead a high-performing team of TPA professionals, providing guidance, support, and mentorship.

- Define team goals, objectives, and performance expectations aligned with the hospital's overall strategy.

- Conduct regular training and development programs to enhance the team's knowledge and skills.

- Foster a positive work environment that encourages collaboration, innovation, and continuous learning.

4. Financial Analysis and Reporting:

- Analyze financial data related to Insurance Growth.

- Prepare monthly reports, forecasts, and budgets to monitor the financial performance of Insurance/TPA and team members (unit wise)

- Identify cost-saving opportunities and implement strategies to optimize expenses without compromising quality or compliance.

- Maintain trackers to ensure monitoring of renewals / expiry and timely negotiating for revision of rates

5. Compliance and Regulatory Requirements:

- Ensure compliance with applicable laws, regulations, and industry standards related to claims processing, privacy, and data security.

- Stay updated with changes in healthcare regulations and insurance policies affecting TPA operations.

- Implement processes and controls to maintain data accuracy, confidentiality, and integrity.

Requirements:

- Bachelor's degree in healthcare administration, business management, or a related field (Master's degree preferred).

- Proven experience (5 years or more ) in a similar TPA leadership role within the hospital industry at Corporate/India level

- In-depth knowledge of healthcare insurance, claims processing, and reimbursement practices. Established relationship with partners and stakeholders in the industry

- Familiarity with relevant laws, regulations, and industry standards.

- Strong leadership and team management skills with the ability to inspire and motivate a team.

- Excellent communication, NEGOTIATION, and interpersonal skills to build and maintain relationships with stakeholders.

- Analytical mindset with the ability to analyze financial data, identify trends, and make data-driven decisions.

- Can drive and contribute individually within a matrix organization , go getter and high on execution

- Proficiency in using healthcare software systems, electronic medical records (EMRs), and claims processing platforms.