Walk-in || Senior Manager / Manager - Provider Network

1. Network Expansion & Strategic Empanelment

• Identify geographic and specialized care gaps in the existing network to drive targeted provider empanelment.
• Evaluate, onboard, and empanel new hospitals, day-care centers, diagnostic chains, and specialized medical facilities based on quality, capacity, and geographical needs.
• Drive the end-to-end credentialing process, ensuring all network providers meet company standards, quality benchmarks, and accreditation criteria (e.g., NABH/JCI or local healthcare regulatory standards).

2. Tariff Negotiation & Cost Containment

• Lead high-stakes negotiations on tariffs, package rates, and fee schedules with provider management and hospital leadership to optimize cost efficiency.
• Establish favorable discount structures, volume rebates, and payment terms to drive claim cost-containment initiatives.
• Conduct periodic reviews and re-negotiations of existing contracts and MOUs upon renewal.

3. Provider Relationship Management & Governance

• Serve as the senior point of escalation for complex provider grievances, billing disputes, claim denials, and delayed payments.
• Conduct periodic performance reviews with key network hospitals regarding cashless turn-around-time (TAT), query resolution rates, and billing accuracy.
• Oversee regular audits and surprise facility visits to evaluate service quality, prevent fraud, waste, and abuse (FWA), and maintain network integrity.

4. Operational Integration & Claims Alignment

• Partner closely with internal Claims, Pre-Authorization, Fraud/Risk Management, and IT teams to streamline cashless request processing and claim settlement workflows.
• Ensure seamless data integration between hospital management systems (HMS) and TPA platforms to drive automation and reduce manual paper flow.
• Manage provider master data, ensuring directories, rate cards, and network status updates are accurate across consumer-facing platforms and portals.

5. Leadership & Regulatory Compliance

• Lead, mentor, and build high-performing Provider Relations Officers and Network Managers across target zones.
• Ensure strict adherence to insurance regulatory guidelines (e.g., IRDAI, CMS, state health laws, or delegated oversight mandates) regarding provider contracts and cashless administration.
• Oversee the continuous development and updating of the Provider Manual and onboarding documentation

• Send your resume to [email removed]