Magma HDI General Insurance - Zonal Head - Healthcare Provider Management

Key Responsibilities:

- Provider Network Management: Build and manage a high-quality and cost-efficient network of healthcare providers, ensuring the right geographical spread to serve our members effectively.

- Contracting & Negotiation: Lead provider contracting efforts, including negotiations for quality and cost-efficient services during both empanelment and rate-revisions. You will also be responsible for regular case management negotiations.

- Operational Oversight: Manage all end-to-end Provider Network operations in the zone, ensuring smooth and efficient processes.

- Fraud, Waste & Abuse (FWA) Prevention: Proactively identify potential leakages and implement measures to prevent FWA, protecting company assets and ensuring fair claims practices.

- Cost Control & Monitoring: Maintain close monitoring and control of ACS (Average Cost per Stay), aiming for cost efficiency without compromising on quality of care.

- Due Diligence & Agreements: Be hands-on with the provider due diligence process and execute bi-partite and tripartite agreements.

- Cross-functional Coordination: Collaborate effectively with internal teams such as sales, operations, and underwriting to ensure a seamless service experience for all stakeholders.

- Industry Awareness: Stay informed about the latest trends and developments in the health insurance and healthcare sector and a deep understanding of regulatory guidelines.

Specialized Skills & Competencies:

- Hands-on with Provider Network Management: Proven experience in building, managing, and optimizing a network of healthcare providers.

- Strong Relationships: Established relationships with corporate hospitals and key stakeholders in the healthcare ecosystem.

- Regulatory Understanding: A solid grasp of regulatory guidelines governing the health insurance sector.

- Industry Awareness: A keen awareness of the latest trends, technological advancements, and policy changes in health insurance and healthcare.