Assistant Vice President - Provider Network Management - Hospital Empanelment/Insurance

Role - Provider Network Management

Location - Mumbai /Bangalore /Hyderabad

Reporting To - Head - Network Management

Must be working with General Insurance / Health Insurance

Job Summary:

We are looking for a dynamic and strategic leader for Provider Network Management. The role will be responsible for development, expansion, and governance of the hospital network across designated zones in India.

The incumbent will drive network strategy, provider contracting, SLA negotiations, tariff optimization, cost containment, and quality assurance to ensure seamless, high-quality, and cost-effective healthcare service delivery for customers.

Key Responsibilities:

1. Strategic Network Development:

- Cashless Hospital Network Expansion: Develop and execute a comprehensive strategy to empanel hospitals across key business geographies.

- Provider Contracting & Strategic Purchasing: Lead tariff negotiations and finalize contracts aligned with health plan requirements.

- Relationship Management: Build strong, long-term relationships with hospital management and key stakeholders to create competitive advantage and ensure service excellence.

2. Operational Leadership:

- Team Management: Lead and mentor a team of network managers and executives across zones. Drive performance in tariff negotiations, provider purchasing, audits, and relationship management.

- Digital & Process Excellence: Design and streamline digital workflows for provider onboarding, credentialing, renewals, and contract lifecycle management.

- Cross-Functional Collaboration: Work closely with Claims, Sales, Operations, and Customer Support teams to ensure seamless healthcare service utilization and superior customer experience.

3. Cost Optimization & Quality Assurance:

- Tariff Optimization: Analyze market intelligence and utilization trends to ensure competitive and sustainable pricing structures.

- Cost Containment & Leakage Prevention: Implement strategies for fraud control and cost management across network and non-network providers.

- Quality Governance: Ensure adherence to healthcare quality standards (e.g., NABH compliance) and establish mechanisms to monitor and reward provider performance.

Candidate Profile:

Experience:

- 7+ years of overall experience in healthcare or insurance industry.

- Proven track record in hospital empanelment, tariff negotiations, cost savings, and network expansion.

- Prior experience with a Health Insurance Company, TPA, or Large Hospital Chain preferred.

Qualifications:

- Postgraduate degree (MBA in Healthcare Management / Hospital Administration / Marketing preferred).

- Clinical qualification (MBBS / BHMS / BAMS) combined with management degree will be highly valued.