Cluster Manager - PN (Chandigarh)

Aditya Birla Health Insurance Company Limited; Punjab; On-site; INR 1,500,000 - 2,300,000; Full time

Job summary

Aditya Birla Health Insurance Company Limited is looking for a Cluster Manager, Healthcare Network & Operations, to lead provider network development and management across multiple geographies. You will evaluate hospitals, clinics, diagnostic centers, and other partners to enhance service delivery for ABHI policyholders.

The role requires leadership experience in health insurance, strong negotiation skills, and strategic oversight of provider relations.

Qualifications

• Have a degree or a management degree (healthcare management is preferred)
• Have 6-8yrs exp in health insurance with at least 5+ years’ experience in leading provider network teams
• Have experience with developing provider networks from scratch
• Able to make quick decisions and have good judgment and analytical skills
• Have excellent verbal and written communication skills and strong negotiation skills.
• Always open to embracing change and be able to manage it
• Passionate about building highly engaged teams

Responsibilities

• Identify Healthcare Service provider partners including Hospitals, Doctors, Diagnostic centers, and other service providers
• Develop and manage a robust provider network in the assigned geographical area
• Maintain relationships and all provider relations activities in the assigned geography
• Analyze Health Insurance industry and competitor landscape for market intelligence
• Plan and execute co-branding activities to boost provider visibility
• Support Regional Network Team and implement industry best practices to achieve success
• Negotiate and renegotiate contracts with physicians and provider groups
• Monitor reports to ensure compliance requirements are met and tracked
• Report to Zonal and leadership teams on status, risks, and opportunities
• Handle payment reconciliation and address provider grievances; produce MIS reports
• Monitor and drive case management negotiations with network hospitals
• Identify fraud/abuse and leakage; ensure controls
• Identify opportunities for repricing and renegotiation of tariffs and packages
• Willing to travel across geographies to maintain provider relationships

Skills

Provider network

Negotiation

Contracting

Leadership

Analytical skills

Communication skills

Education

Healthcare management

Job description

Cluster Manager- JD - Location: Multiple (West & South)

As a Cluster Manager of Healthcare Network & Operations, your typical week might include the following

• Identify Healthcare Service provider partners include Hospitals, Doctors, Diagnostic centers / vision, and dental centers / home care treatment providers /allied medical service providers, and other partners that will add value in services for ABHI policy holders
• Deep understanding on Health care eco system & innovate ideas on service level engagements with Hospitals / Diagnostic centers / Clinic & Other service care providers
• Development and management of an adequate provider network in assigned geographical area
• Maintaining relationships and all provider relations activities in assigned geographical
• Analyze and understand Health Insurance industry and competitor landscape & Market intelligence on competitors
• Plan & execute Co-branding activities and bring brand visibility among the Service providers
• Support of Regional Network Team & implement industry best practices as required to achieve success for ABHI
• Negotiating and renegotiating contracts with physicians and Healthcare provider groups
• Monitoring of various reports to ensure all necessary compliance requirements are met and maintained
• Reporting to Zonal & leadership team on status, risks, and potential opportunities in area of responsibility on a regular basis
• Payment reconciliation, addressing Provider grievances & carrying our region wise MIS reports in responsible geographies
• Monitor, drive case management negotiations with Network hospitals in assigned geographies
• Able to identify, monitor fraud/abuse and leakage
• Able to effectively identify opportunities for repricing and renegotiations of the Tariff / Packages / Discounts with healthcare providers
• Willing to Travel across geographies and maintain relationship with healthcare partners

You could be the right candidate if you

• Have a degree or a management degree (healthcare management is preferred)
• Have 6-8yrs exp in health insurance with at least 5+ years’ experience in leading provider network teams
• Have experience with developing provider networks from scratch
• Able to make quick decisions and have good judgment and analytical skills
• Have excellent verbal and written communication skills and strong negotiation skills.
• Always open to embracing change and be able to manage it
• Passionate about building highly engaged teams

This could be the gig for you if you…

• Are passionate about consumer behavior and culture; enjoy spending time with customers/providers to understand what they really want. Have an attentive ear listen to new ideas
• Thrive in environments that celebrate co-creation and collaboration
• Are passionate about leveraging digital tools to transform customer experience
• Like to work in a culture where everyone can see what others are doing
• Take help from others when stuck and encourage others when there are setbacks
• Take full responsibility for your team’s contribution while thinking wing to wing across the organization; to solve for the customer