Manager -PN (Indore))

Aditya Birla Capital; Haryana; On-site; INR 1,400,000 - 2,000,000; Full time

Job summary

Aditya Birla Capital is looking for a Head – Provider Network for its health insurance unit. This role requires managing provider relationships, expanding networks, and controlling average claim sizes. The ideal candidate will lead the strategy for the provider network across India, ensuring compliance while achieving cost efficiency.

Responsibilities include negotiating contracts, implementing network strategies, and leading a team. Candidates with extensive experience in health insurance provider networks and strong negotiation skills will thrive in this position.

Qualifications

• Extensive experience in health-insurance provider network management.
• Strong negotiation, partnership, and strategic-planning skills.
• In-depth knowledge of hospital, diagnostic, and welfare-service ecosystems in India.
• Proficiency in digital platforms, data analytics, and automation.
• Leadership experience in managing cross-functional teams.

Responsibilities

• Lead strategy formulation and execution for the Provider Network across the country.
• Build and maintain relationships with hospitals and diagnostic centres.
• Negotiate tariffs and contract terms to keep average claim size within targets.
• Manage OPD and wellness partners ensuring timely delivery of claims.
• Create and manage a pan-India DC network via aggregators.

Skills

Negotiation skills

Partnership management

Strategic planning

Digital platform proficiency

Data analytics

Job description

Overview

Position: Head – Provider Network Business: Financial Services Unit: Aditya Birla Health Insurance Company Ltd Location: MBC, Thane Reports to: Chief Operating Officer Designation: Vice President Date of JD: Jan 2024

Job Purpose

The role leads the design and execution of the Provider Network strategy for ABHI. It manages partner relationships, expands hospital and diagnostic networks, controls average claim size, negotiates tariffs, and creates preferred provider bundles. Additionally, it oversees OPD/wellness partners, health‑tech collaborations, and a pan‑India diagnostic center (DC) network.

Core Responsibilities

• Lead strategy formulation and execution for the Provider Network across the country.
• Build and maintain relationships with hospitals, diagnostic centres, pharmacies, consultants, and home‑care providers.
• Negotiate tariffs and contract terms to keep average claim size (ACS) within target limits.
• Expand the partner network to cover all relevant geographies and product distribution channels.
• Manage OPD and wellness partners, TPAs, and health‑tech vendors, ensuring timely delivery of claims and services.
• Evaluate new technology partners and ensure they meet customer service and commercial objectives.
• Create and manage a pan‑India DC network via aggregators and direct ties.
• Ensure compliance with regulatory and supplier‑management requirements (e.g., ROHINI registration, fraud monitoring).
• Collaborate with internal teams – claims, underwriting, pricing, and IT – to optimise network operations and cost.
• Lead a team of network specialists, driving training, performance, and development.
• Report on key metrics such as network size, volume, cost control, and customer satisfaction.

Key Result Areas (KRAs) & Supporting Actions

• Provider Network Quality: Build a quality provider pool, ensuring availability at optimal cost.
  • Design network strategy and map contacts.
  • Create and manage direct empanelment initiatives.
• Commercial Negotiations: Execute negotiations to secure favourable tariffs while keeping ACS controlled.
  • Analyse cost variances and benchmark against industry.
  • Maintain profitability during contract and hospitalization negotiations.
• Customer Experience: Enhance cashless utilisation and overall service quality.
  • Implement GIC/IRDA coordination for non‑network hospitals.
  • Conduct quality surveys and manage hospital experiences.
• Team Management: Define roles, training plans, and development initiatives.
  • Onboard members and provide role‑specific training.
  • Facilitate continuous learning.
• Compliance & Regulation: Ensure adherence to all provider‑network regulations.
  • Drive registration and due‑diligence.
  • Align MIS with finance and regulatory reporting.

Key Challenges

• Rapidly setting up a nationwide professional network.
• Negotiating competitive tariffs in a provider‑dominant market.
• Maintaining quality across a large, geographically dispersed network.
• Managing data and system integration for unorganised healthcare providers.
• Implementing automation and digital claim adjudication.
• Negotiating contracts and monitoring performance with multiple TPAs.
• Customising solutions for corporate and group business while staying within budget.

Relationship Management

• Internal: Underwriting, Claims, Customer Service, Pricing, Sales, Legal & Compliance, Digital & IT.
• External: Healthcare providers, TPAs, technology partners, group HR, wellness partners, affinity partners, industry forums.

Qualifications

• Extensive experience in health‑insurance provider network management.
• Strong negotiation, partnership, and strategic‑planning skills.
• In‑depth knowledge of hospital, diagnostic, and welfare‑service ecosystems in India.
• Proficiency in digital platforms, data analytics, and automation.
• Leadership experience in managing cross‑functional teams.

Benefits

Legal‑required equal‑employment‑opportunity statement and benefit details are available upon request.