Senior Manager - Provider Network - Health Insurance

Senior Manager - Provider Network

Location : Chennai/ Bengaluru

Company : Fast Growing Health Insurance Company

Job Purpose :

- Responsible for creating and managing in house network for IPD, OPD & wellness program for the zone/region.

- The candidate will be required to liaise with hospitals/nursing homes as well as wellness partners on daily/periodical basis with objective of facilitating and managing business relations.

- She/he will also be required to liaise with corporate partners/brokers in their region in order to see the smooth functioning of claims processing and Network Management

- Current location responsibility is South & East zone. Zones can be realigned as per need.

Key Responsibilities :

- Liaise with hospitals/nursing homes/wellness partners on a daily/periodical basis

- Be an interface between the hospitals and the company's claims/customer service team

- Be actively involved in organizing wellness & health camps/services in corporate's

- Ensuring tie ups with in stipulated time frame

- Provider contracting and tariff negotiation on the best available rates

- Responsible for overall activities related with empanelment of hospitals/nursing homes/wellness vendors

- Updating records and network presence intermittently

- Maintaining and publishing dashboard for empanelment, savings and de empanelment

- Periodic audit of Network providers/TPA's with random onsite visits

- Ensure adequate tracking mechanism is in place to quantify the cost savings through negotiated tariffs

- Works in co-ordination with the providers to ensure superior health care delivery at hospitals

- Ensure adequate measures are in place to identify fraudulent activities at providers and take timely action

Knowledge/Experience/Skills :

- Over 8 years experience in provider contracting/wellness vendor management

- Strong proficiency with MS Excel and MS Power point

- Previous experience of managing provider network with Health, General Insurance co./TPA

- Familiarity with key hospital management team

- Health care market intelligence

- Graduate with Insurance knowledge and understanding of IRDA guidelines and compliance

- Thorough understanding of wellness products

- In depth understanding of IRDA guidelines and compliance

- Excellent oral and written communication

- Customer service skills

- Negotiation Skills

- Insurance Operations