Company Name - A leading General Insurance Company
Job Title: Regional Provider Manager
Role: Provider Network Management
Department: Provider Management- Health Claims
Location: Goregaon
Lead/IC Individual Contributor
Band Band (3)
Job Description
POSITION OVERVIEW - This role is responsible for the development, expansion, and management of the hospital network in the assigned region. This role will be responsible for network hospital relations, Discount and tariff negotiations, ensuring operational efficiency and seamless quality service delivery.
ROLE AND RESPONSIBILITIES -
v To execute the strategic network development through new empanelment
and renewals.
v To be responsible for tariff negotiations.
v Relationship management: To ensure operational efficiency and quality
service delivery.
v Foster effective co ordination and collaboration with internal and
external stakeholders to support cross-functional initiatives and process
optimization.
v Fraud & abuse management.
v Maintaining high quality healthcare standards: Monitor high standards
of quality and patient safety within the network hospitals. Ensuring
compliance with healthcare quality standards as per IRDAI guidelines.
v Data analysis: Use data-led analytics to continuously monitor network
provider performance, utilization patterns, and patient feedback to generate
actionable insights.
v Regulatory and Management Reporting: Prepare and present performance
reports to senior management and key stakeholders like IRDAI.
KEY DECISIONS TAKEN -
EDUCATION & EXPERIENCE REQUIREMENTS –
v A Graduate degree/Medical Graduate degree / MBA in Healthcare
Management or Hospital Administration or Marketing
v 5+ years of overall experience in the healthcare or insurance industry
in a similar role in an insurance company or a TPA.
PREFFERED SKILLS –
v Communication: Excellent verbal and written communication skills for
effective stakeholder engagement.
v Industry knowledge: Deep understanding of the Indian healthcare
ecosystem, market dynamics, and regulatory landscape.
v Analytical skills: Strong analytical and data evaluation skills for
performance monitoring and strategic planning.
v Strategic mindset: Ability to think strategically with an execution-oriented mindset.
Apply through whichever channel suits you best.