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TPA & INSURANCE HEAD
Ayurveda Hospital | Full-Time, Onsite | New Delhi, India
SALARY: INR 1,00,000 – 1,50,000 per month | Full-Time, Onsite | Immediate Joining Preferred
�� Location
New Delhi, India
�� Type
Full-Time, Onsite
�� Experience
5–10+ Years
�� Education
Graduate / MBA
ABOUT THE HOSPITAL
Arogya Dham Ayurveda Hospital is a NABH-accredited multi-specialty Ayurveda centre located in New Delhi, India, offering integrated traditional and modern healthcare across 120+ beds, 30+ specialist physicians, and empanelled with 25+ insurance providers and government health schemes. We are committed to making authentic Ayurvedic healing accessible to every patient — and our insurance operations are central to that mission.
ROLE SUMMARY
Reporting directly to the Hospital Director, the TPA & Insurance Head will lead all insurance and TPA operations including cashless approvals, claim processing, insurer empanelment, IRDAI compliance, and billing coordination. The ideal candidate brings 5–10+ years of hospital insurance experience, a strong command of claim workflows, and the ability to lead a team in a specialised Ayurveda healthcare setting.
KEY RESPONSIBILITIES
1. Empanelment & Insurer Relations
• Identify, negotiate, and execute empanelment agreements with TPAs, PSUs, and private insurance companies
• Maintain and periodically renew MoUs with all empanelled insurers; track expiry calendars
• Build relationships with TPA desk officers and insurer grievance teams to expedite claim decisions
• Expand government scheme coverage: Ayushman Bharat (PMJAY), CGHS, ECHS, state schemes
• Benchmark hospital tariffs against industry norms and negotiate competitive packages
2. Cashless & Claim Processing
• Oversee end-to-end cashless authorisation: pre-auth, enhancement, and discharge approvals
• Ensure TAT compliance for pre-authorisation (<4 hours) and claim submission (<72 hours post-discharge)
• Manage reimbursement and cashless claim files; ensure ICD-10 and CPT coding accuracy
• Coordinate with the clinical team for medical record completeness and claim documentation
• Establish and maintain a daily claim tracker and MIS dashboard for hospital leadership
3. IRDAI Compliance & Policy Adherence
• Ensure full compliance with IRDAI regulations, TPA guidelines, and hospital insurance policies
• Monitor regulatory updates and circulate policy changes to relevant departments
• Conduct periodic internal audits of insurance documentation and coding practices
• Liaise with legal/compliance teams on disputes, arbitration, or regulatory communications
• Maintain confidentiality and integrity of patient and claim data per applicable law
4. Team Management & Training
• Lead, mentor, and evaluate a team of 5–10 insurance executives and billing coordinators
• Design SOPs for cashless desks, claim submission workflows, and query resolution
• Conduct regular training on insurer-specific protocols, coding standards, and soft skills
• Set KPIs for team members; review performance monthly and conduct appraisals
5. Revenue Optimisation & MIS Reporting
• Minimise claim rejections and shortfalls; implement root-cause analysis for denials
• Track outstanding receivables from TPAs/insurers and drive collections within 30-day cycles
• Prepare weekly/monthly MIS reports: claim volumes, settlement ratios, pending auth status
• Identify revenue leakage and implement corrective action plans
• Provide data-driven insights to management for pricing and empanelment strategy
REQUIRED SKILLS & EXPERIENCE
• 5–10+ years of progressive experience in hospital TPA/insurance operations
• Demonstrated expertise in cashless claim management, pre-auth, and reimbursement workflows
• Working knowledge of IRDAI regulations, TPA guidelines, and hospital billing standards
• Proficiency in ICD-10 medical coding and health insurance terminologies
• Experience managing empanelment with PSU, private insurers, and government health schemes
• Strong leadership skills; prior experience managing a team of 5+ members
• Excellent negotiation, communication, and stakeholder management skills
• Proficiency in Hospital Management Systems (HMS) and MS Office (Excel, Word)
• Graduate in any discipline; MBA (Healthcare/Hospital Administration) or equivalent preferred
• Willingness to work onsite full-time in New Delhi
PREFERRED QUALIFICATIONS
• Prior experience at an Ayurveda, Naturopathy, or AYUSH hospital strongly preferred
• Certified Medical Coder (CPC, CCS, or equivalent) or insurance certification is an asset
• Familiarity with Ayushman Bharat (PMJAY), CGHS, ECHS, and state health scheme portals
• Knowledge of NABH accreditation standards related to insurance and billing
• Multilingual ability (Hindi + English); proficiency in additional regional languages is a plus
• Exposure to digital health insurance platforms, e-claims portals, or InsurTech tools
KPIS / PERFORMANCE METRICS
• Cashless pre-authorisation TAT: ≤4 hours (target 95% compliance)
• Claim submission TAT: ≤72 hours post-discharge (target 98% compliance)
• Claim rejection rate: maintained at <5% (monthly)
• Outstanding TPA/insurer receivables: cleared within 30-day billing cycle
• Number of new empanelment agreements executed per quarter (target: 2+)
• Team productivity: claim processing volumes per executive per month
• Patient grievance resolution rate related to insurance: >98%
• MIS reporting: 100% on-time submission of weekly and monthly dashboards
• Revenue recovery from denials via appeal: >70% of contested claims
SALARY RANGE & BENEFITS
SALARY RANGE
INR 1,00,000 – 1,50,000 / month
+ Performance Bonus & Benefits
Benefits Include:
• Group Health Insurance (employee + family)
• Annual performance bonus (up to 10%)
• Paid leaves: 15 CL + 15 SL per year
• Provident Fund & Gratuity (statutory)
• Complimentary Ayurveda treatments
• Professional development allowance