Head – Insurance

Company Overview

Auresta Healthcare Pvt. Ltd. (Parent company of Smartvision) is a fast-growing, quality-driven healthcare group committed to patient-centric services. The company focuses on building strategic partnerships that enhance patient access and business growth within the healthcare delivery and insurance ecosystems.

Job Summary

The Head – Insurance is responsible for building, managing, and strengthening strategic relationships with insurance companies and Third-Party Administrators (TPAs). This role ensures seamless patient access, timely reimbursements, and business continuity for all subsidiaries of Auresta Healthcare. The ideal candidate will have a combination of in-depth insurance industry knowledge and recent hospital experience, acting as the primary liaison between the organization and insurance stakeholders.

Responsibilities

• Strategic Relationship Management

  • Develop and maintain strong relationships with senior leadership at insurance companies and TPAs.
  • Negotiate empanelment terms, tariffs, and service agreements to ensure competitive positioning.
  • Act as the escalation point for any disputes or operational issues with payers.

• Business Continuity & Revenue Assurance

  • Ensure uninterrupted cash flows by proactively managing claim approvals, discharges, and reimbursements.
  • Identify risks that could disrupt insurance-related business operations and implement mitigation strategies.
  • Monitor and improve claim settlement turnaround times.

• Operational Excellence

  • Standardize processes for pre-authorization, billing, claim submission, and denial management across hospital units.
  • Train and guide hospital insurance desks to deliver consistent, high-quality patient service and documentation accuracy.
  • Implement technology-driven solutions for claim tracking and analytics.

• Compliance & Governance

  • Ensure adherence to IRDAI (Insurance Regulatory and Development Authority of India) guidelines, insurance contracts, and hospital policies.
  • Maintain complete, auditable documentation for all insurance-related transactions.
  • Stay updated on regulatory changes impacting health insurance and hospital empanelments.

• Stakeholder Collaboration

  • Work closely with hospital operations, finance, and medical teams to align insurance processes with patient care objectives.
  • Partner with marketing teams to drive insurance-led patient acquisition initiatives.

Qualifications

• Experience & Background

  • 10–15 years of experience in health insurance and hospital administration, with the recent 3–5 years in hospital insurance desk/relationship management.
  • Proven track record of managing empanelments, negotiations, and escalations with insurance companies and TPAs.
  • Strong operational and financial acumen in insurance-related hospital processes.

• Skills & Competencies

  • Excellent negotiation and relationship management skills.
  • Strong analytical skills with experience in claim data interpretation.
  • High level of integrity, professionalism, and customer orientation.
  • Ability to navigate complex multi-stakeholder environments.

• Education

  • Graduate in any discipline; MBA/PGDM in Healthcare Management, Insurance, or equivalent preferred.

Preferred Skills

• Familiarity with regulatory frameworks and compliance requirements.
• Experience with data analytics tools in healthcare insurance settings.

Experience

• 10–15 years of relevant experience in health insurance and hospital administration, with recent experience in relationship management.

Environment

• The position is based in Delhi, with an expectation of close collaboration with various departments within the organization. The role requires a professional demeanor, stakeholder management ability, and adaptability to a fast-paced healthcare environment.

Salary

• Salary details are not specified.

Growth Opportunities

• Opportunities to influence strategic partnerships that directly impact business growth and patient access within the organization.

Benefits

• Not specified.