Manager- PN

Aditya Birla Insulators; Patna; On-site; INR 900,000 - 1,500,000; Full time

Job summary

Aditya Birla Health Insurance (ABHI) is seeking a professional to manage its provider network of hospitals, clinicians, and other healthcare providers within a defined region. The role includes negotiating contracts, building strong provider relationships, and ensuring high-quality, cost-effective services for ABHI customers.

The incumbent will work closely with the Customer Services and Operations teams to deliver timely, high-value healthcare solutions while maintaining regulatory compliance

Qualifications

• Experience negotiating provider contracts and renewals.
• Ability to manage provider relationships and monitor KPIs.
• Familiarity with regulatory requirements and TPA processes.

Responsibilities

• Contribute to provider strategy development within a region, aligning with ABHI objectives.
• Negotiate commercial contracts and renewals to ensure access to quality care at sustainable costs.
• Own relationships with providers, monitor KPIs, and escalate issues as needed.
• Collaborate with internal stakeholders across ABHI and Aditya Birla Group for service delivery.
• Manage TPA relationships with India-wide scope, including monthly reconciliations and SLA adherence.

Skills

Provider network management

Contract negotiation

Stakeholder management

KPI monitoring

TPA coordination

Job description

Job Purpose

The job holder is a key member of the team responsible for managing Aditya Birla Health Insurance (ABHI) provider network of hospitals, clinicians and other healthcare providers within a defined geographical region, ensuring customers are able to readily access high quality, cost effective, customer focused healthcare when they need it. The team is charged with the development, maintece and management of a recognised provider network within its allocated region. The job holder will own the endto end relationship with allocated healthcare providers within their geographical region. This will include the negotiation and management of new and existing provider contracts to improve the quality and value of services available to ABHI customers including cashless direct settlement. The job holder will work closely with the rest of the Customer Services and Operations team, and across the business to ensure the timely delivery of high value, high quality services to ABHI customers.

Job Context & Major Challenges

About the Health Insurance Industry

While the current market sees more than 15 nonlife players in the private space and 5 exclusive private players in the health insurance space trying to capture a sizable market share, the nationalised service provider (6) remains a strong competitor. In addition to this the business dynamics are such that the overall market on an annual basis which is to the tune of roughly 10, 000 Crs sees close to 85 % of the business renewing with the existing service provider itself. This narrows down the opportunity of the fresh business actually being seriously fought in the market to approximately 1500 odd Crs. With the SME and the startups being the driving force of Indian economy, the opportunity to cater to these segments is immense and is increasing manifold year on year. The challenge here therefore remains as to how we capture a larger share of the opportunity by developing specific solutions to cater each segment of the business. Also by creating an inexpensive and standardized solution to increase the reach into the pockets of channel partners across the country to harness on their captive business and explore new opportunities with them.

Opportunities With the advent of medical advancements, lifestyle changes, change in Indian socioeconomic scenario and Indian healthcare space the clients are facing challenges to cater to the needs of diverse workforce. Increasingly Indian clients have started considering group benefits as a lever to manage employee expectations, talent acquisition and retention. In this scenario it becomes extremely important to understand their psyche and then provide tailored solutions which would help them meet their end objectives and bring in profitable revenue source for the company

Challenges

Distribution: How we create specific distribution models to penetrate different market segments remains a challenge. Motivation to channel partners to place business with the co. Activate and manage agent based distribution channel across the country

Long term and short term strategic plans to increase the market share and profitability in line with the company s business objectives.

Identifying new segments, structure offerings, and value enhancers apart from creating differentiators remains a big challenge for the company s growth. Meeting varied client s expectation in terms of solutions, pricing and operational support remains a challenge.

Build and further enhance relationships with key customers and partners alike.

Build the vertical in line with the leadership teams expectation of having the group benefits team contributing substantially to the bottomline in years to come

Key Result Areas KRA (Accountabilities) (Max 1325 Characters) Supporting Actions (Max 1325 Characters)

KRA1: Managing provider network of hospitals, clinicians and other healthcare providers

• Contribute to the implementation, development and maintece of ABHIs provider strategy within an allocated region, ensuring alignment with ABHIs overall business strategy and provider strategy.
• Negotiate appropriate commercial contracts and renewals with allocated providers in a timely manner to allow customers access to quality healthcare at sustainable cost structures and rates.
• Using standard funding models and fee structures negotiate commercial deals on the best possible terms for ABHI, including risk sharing with providers.
• Own the relationship with allocated providers, including regular review and monitoring of KPIs, review meetings, escalation point for issues, etc.
• In collaboration with Provider Network Manager, research availability and quality of healthcare provision in allocated region, including opportunities where new capacity is being developed.
• Develop and extend the network to give wider geographical and provider coverage (eg diagnostic centres, speciality centres, doctors, etc) as required by the Provider Network Manager.

KRA2: Managing provider network of hospitals, clinicians and other healthcare providers

• Form effective working relationships with key internal stakeholders in ABHI, and within Aditya Birla Group where appropriate.
• Proactively support, advice and coach providers to strengthen relationships and manage costs.
• Obtain feedback and recommendations from providers and disseminate to the relevant Customer Service and Operations departments to improve levels of service to customers.
• Regularly review and monitor data including claims volumes, spend, procedure volumes, and provider behaviour to ensure that opportunities for claims spend savings are highlighted.
• To understand, comply with and abide by the regulatory requirements.
• Responsible for TPA relationship management across India and provide monthly, quarterly reconciliation reports and SLA adherence.
• Lead in TPA audit and recovery process from Provider Contracts team.