Insurance Network Program Manager- Bangalore ,Mumbai ,Noida, Hyderabad

Job Title: Senior Manager Provider Network

Department: Provider Network Management / Hospital Relations

Reports To: Head / Director Provider Network & Operations

Job Purpose

The Senior Manager – Provider Network will lead the expansion, governance, and operational integration of the health insurer’s hospital network. This role oversees end-to-end hospital participation, ensuring strict tariff compliance, service quality SLAs, monthly billing and reconciliation, and technology/digital readiness for seamless cashless processing.

Key Responsibilities

• Hospital Onboarding & Network Expansion:
  
• Oversee end-to-end onboarding and empanelment of hospitals, day-care centers, and diagnostic chains into the insurer's network.
• Lead strategic contracting, rate negotiations, and agreement renewals with hospital management and leadership.
• Tariff Compliance & Quality SLAs:
  
• Enforce hospital adherence to agreed-upon package tariffs, discount structures, and contract terms to control medical inflation.
• Monitor and enforce Service Level Agreements (SLAs) regarding cashless turnaround times (TAT), query responses, and care quality.
• Conduct periodic performance reviews and audit network hospitals to prevent billing inflation, unnecessary treatments, or fraud.
• Billing, Accounting & O/S Management:
  
• Manage monthly billing cycles, hospital claim submission reconciliation, and account settlements.
• Oversee outstanding (O/S) payment balances, resolve billing disputes, and ensure timely settlement to maintain strong hospital relations.
• Tech Readiness & Digital Integration:
  
• Drive hospital tech enablement—ensuring provider integration with the insurer's portal/API systems for digital claims, pre-authorizations, and real-time status tracking.
• Ensure hospital desk staff are trained on internal platforms for smooth digital document submission and cashless request workflows.
• Escalation & Cross-Functional Coordination:
  
• Act as the senior escalation point for unresolved query management, claim denials, pre-auth delays, and hospital grievances.
• Work closely with internal Claims, Medical Audit, Pre-Auth, and IT teams to streamline operational workflows

Thanks & Regards

Hariprasad