Provider Network & Hospital Empanelment

Greeting From Link-K Insurance TPA Pvt Ltd

We are hiring Provider Network Management at our Chennai Corporate Office.

Job Role: Provider Network Management

Industry: TPA/Health Insurance

Location: Chennai, Tamil Nadu

Experience: 5 Year to 8 Years

Qualification: Graduate in any discipline

Roles & Responsibilities:

• Define empanelment process, finalizing communication material
• Identify and empanel hospitals, clinics, diagnostic centers, and other healthcare providers to join the network.
• Defining categories of hospitals, grading and appropriately mapping
• Maintain hospital network master with clean data and appropriately flag suspected hospitals
• Analyze market trends, insurance company and client requirements and geographical spread to identify potential gaps in the network.
• Evaluate the quality of healthcare providers based on accreditation, facilities, and medical staff credentials.
• Negotiate contracts, package rates and discounts with healthcare providers to ensure competitive pricing while maintaining quality standards.
• Collaborate with legal and compliance teams to draft and finalize contracts that meet regulatory requirements and protect the interests of the TPA and its clients.
• Build and maintain strong relationships with hospital administrators, medical directors, and key stakeholders to facilitate seamless cashless claims management
• Coordinate and help cashless team in the events of disputes at the time of admission/discharge of members regarding billing by hospital
• Address and resolve any issues or concerns raised by network providers promptly and professionally.
• Implement performance metrics to assess the efficiency and quality of services provided by network hospitals.
• Continuously assess the network's adequacy and identify opportunities for expansion or optimization.
• Collaborate with the business development team to align network growth with the TPA's strategic objectives and market demands.
• Ensure that the network hospitals comply with relevant state & central govt registrations and accreditation requirements.
• Stay updated with changes in healthcare policies and regulations that may impact the network.
• Analyze network performance data and generate reports for management to assess the network's effectiveness and make informed decisions.
• Close coordination with insurers on the network hospital management including empaneling hospitals as per the requirements of insurers.
• Managing the team working for network hospital management across locations.
• Defining the guidelines for hospitals visits and monitoring recording and maintenance of hospital visits
• Constant monitoring of hospitals claims outstanding and coordinate with respective internal stake holders for payment of claims
• Adhering to IRDAI guidelines w r t to de-empanelment process.
• Close coordination with claims team on fraud and abuse control and initiation of appropriate action against hospitals involved in malpractices.
• Constantly comparing the network hospitals count and rates with competition and taking appropriate measures to be best in the industry.

Important Note:

• Health Insurance / TPA Profile only eligible.
• Interested candidate can send your updated resume to careers@linkktpa.com.

Job Types: Full-time, Permanent

Pay: ₹50,000.00 - ₹65,000.00 per month

Benefits:

• Cell phone reimbursement
• Paid sick time
• Provident Fund

Work Location: In person