Director - Networks Head - Healthcare/Insurance

Director - Networks Head

Roles and Responsibilities :

- Partner with the India leadership team in defining and shaping the networks strategy for the India businesses and any new business lines that are created.

- Provide thought leadership and direction and shape organizational practices with focus on strengthening our competitive edge in the market.

- Engage with the global clinical and medical teams in understanding company standards and protocols and ensure alignment of the practices in India with company standards and requirements.

- Provide direction on matters of clinical practices and protocols for new products and services that are developed in company.

- Review ongoing practices from a clinical guidelines and compliance standpoint and ensure the same are in adherence with the local requirements, regulatory requirements and company's Policies and standards

- Regular review of the claims operations with strong focus on medical management and claim adjudication activities.

- Regular review of products, services and process and ensure the same meet the clinical standards and guidelines as required by the local regulations.

- Define the standards and processes for all medical management activities and functions and review the implementation of the same.

- Develop and manage relationships with senior executives in the Provider network with focus on developing innovative solutions, strategic partnerships and alliances

Qualifications and Experience profile :

- MBBS/MD with about 15 years of experience or more

- An understanding of the clinical practices applicable in the insurance industry

- Exposure to insurance medical practices, underwriting will be preferred

- Strong relationship management skills and ability to work with multiple stakeholders.

- Should have maintained the credits/CME requirements in line with the requirements of the MCI

- Should have spent 5+ years in clinical set ups such as hospitals

- People leadership experience in managing medium to large teams.

- Strong communication skills and ability to engage with different levels of employees

- Previous experience in leading and driving change management.

- Strong focus and understanding of the quality processes as they apply to the insurance industry.

- Knowledge and understanding of the hospitals space in India, understanding of the practices, tariffing etc.

- Understanding of the provider business and the ability to engage effectively with senior leadership in hospitals to discuss strategic partnerships and opportunities.