Zonal Head Provider Management

As a member of the Health Claims department, you will be responsible for building and managing a quality and cost-efficient network of healthcare providers in the assigned zone. Your primary focus will be on provider contracting to ensure the right geographical spread and conducting negotiations for quality cost-efficient services during empanelment and rate-revisions. Additionally, you will manage end-to-end provider network operations in the zone, including regular case management negotiations with providers. Your role will involve identifying leakages and implementing measures to prevent fraudulent activities, as well as closely monitoring and controlling the Average Claim Size (ACS). You will be expected to have hands-on experience with provider due diligence processes and the execution of bi-partite and tripartite agreements. Cross-functional coordination will also be a key aspect of your responsibilities. To excel in this role, you should possess specialized skills and competencies such as hands-on experience with provider network management, strong relationships with corporate hospitals, an understanding of regulatory guidelines, and awareness of the latest trends and developments in the health insurance and healthcare sector. The ideal candidate for this position will have 8-12 years of total work experience and hold a Graduation/Post Graduation/MBA degree. If you are passionate about creating a robust provider network and ensuring high-quality healthcare services for our members, we encourage you to apply for this challenging and rewarding opportunity.,