Senior Manager

We are looking for a dynamic and experienced Senior Manager/ Manager to strengthen our Hospital Network function. The role will be responsible for expanding, managing, and optimizing the healthcare provider network while ensuring quality, compliance, and cost efficiency.

Key Responsibilities:

• Define and streamline the empanelment process and finalize communication materials.

• Identify and empanel hospitals, clinics, diagnostic centers, and other healthcare providers.

• Define hospital categories, grading framework, and appropriate mapping.

• Maintain the hospital network master with clean data and properly flag suspected hospitals.

• Analyze market trends, insurer/client requirements, and geographical spread to identify network gaps.

• Evaluate healthcare providers based on accreditation, infrastructure, and medical staff credentials.

• Negotiate contracts, package rates, and discounts with providers to ensure competitive pricing while maintaining quality.

• Collaborate with Legal and Compliance teams to draft and finalize provider agreements.

• Build and maintain strong relationships with hospital administrators, medical directors, and key stakeholders to support seamless cashless claims management.

• Coordinate with the cashless team during admission/discharge disputes related to hospital billing.

• Address and resolve issues raised by network providers promptly and professionally.

• Implement and monitor performance metrics for network hospitals.

• Continuously assess network adequacy and identify expansion or optimization opportunities.

• Work closely with the Business Development team to align network growth with organizational strategy.

• Ensure network hospitals comply with applicable State and Central Government registrations and accreditation requirements.

• Stay updated on healthcare policies and regulatory changes impacting the network.

• Analyze network performance data and generate MIS/reporting for management review.

• Closely coordinate with insurers regarding network requirements and empanelment.

• Lead and manage the hospital network team across locations.

• Define guidelines for hospital visits and ensure proper recording and maintenance.

• Monitor hospital claim outstanding and coordinate internally for timely claim payments.

• Ensure adherence to IRDAI guidelines with respect to de-empanelment processes.

• Coordinate with the Claims team on fraud and abuse control and initiate action against malpracticing hospitals.

• Benchmark network strength and pricing against competitors and implement improvement measures.

Experience:

• 7–14 years of relevant experience in Hospital Network / Provider Management in TPA, Insurance, or Healthcare industry.

• Prior experience in TPA/Health Insurance provider network management is strongly preferred.

Education:

• Graduate in any discipline (Healthcare/Management preferred)