About the role

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.