Provider Network Management

Job Description

Role: Manager – Assistant Manager / Deputy Manager Provider Central Operations Qualification: Graduation/Post-Graduation Minimum Experience: 3-5 years, preferably in Provider management (central operations) in Health insurance or General insurance company Key Responsibilities Area: Performance Tracking & MIS Management Tracking Hospital Empanelment Vs. Targets Tracking Hospital Discount enhancements & packages Tracking Cashless : Reimbursement Ratio Tracking ACS improvement OPD utilization tracking (vendor wise) Data management and analysis Managing Queries & Grievances Publish a Queries & Grievances report every 15 days basis queries received by RMs Obtain a Queries & Grievances report from TPA every month Entering comments received from RMs for empanelment requests received and closing cases in time. Compliance & Governance Ensuring display of updated MCHI Network List on websites MCHI Hospital Locator Management Reconciliation of Network list with the ones getting displayed on TPA websites- monthly SOPs creation and necessary modifications (as per requirements) Annual review of SOPs Show more Show less