TM-Case Management

Aditya Birla Insulators; Thane; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

Aditya Birla Health Insurance in India seeks a Network Manager to build and manage a comprehensive healthcare provider network across the zone, negotiating tariff structures and ensuring delivery of quality services per SLAs. The role involves empanelment planning and expanding hospital and allied networks in districts, cities, and rural areas.

The candidate will lead negotiations, drive cost optimization through discounts, and coordinate with team members to strengthen the provider ecosystem

Qualifications

• Build and manage a comprehensive network of healthcare providers across the zone.
• Negotiate tariff structures and MoUs with providers to secure discounts.
• Ensure delivery of quality services per signed SLAs and renewals.

Responsibilities

• Empanelment planning and network expansion across districts and rural areas.
• Analyze provider portfolio and optimize costs with discounts.

Job description

Job Summary

The role will be responsible for creating, developing managing a comprehensive network of healthcare providers and partners across the Zone along with team members across assigned geography. The role will also be responsible to negotiate best tariff structure for ABHI and manage the renewals and relationships while being responsible for making sure delivery of quality services as per signed SLAs.

Dimensions

• Direct Reports: 1
• Number of Providers Directly responsible along with team members to create and manage relationship with providers across Zones.
• Network of nonhospital Healthcare Providers Network to manage Group, Retail and Rural business
• Planning for Empanelment
• Directly responsible to create OPD IPD network in respective zone in providing seamless experience to customers
• Tariff MoU Negotiation: Responsible for negotiating best tariff validity, and contracting with best discount with the providers to facilitate affordable healthcare delivery for both OPD IPD

Job Context

Major Challenges: Write the specific aspects of the job that provide a challenge (internal and external) to the jobholder in the context of the Business / Unit / Function / Department / Section

In the current market more than 15 nonlife players in the private space and five exclusive private players in the health insurance space are trying to capture a sizable market share, while the nationalized service provider remains a strong competitor. The opportunity to cater to SME and startup segments is immense and is increasing year on year. The challenge is to capture a larger share of this opportunity by developing specific solutions for each segment and by creating an inexpensive, standardized solution to increase reach through channel partners across the country to leverage captive business and explore new opportunities with them.

Market Opportunities: With medical advancements, lifestyle changes, and evolving socioeconomic scenarios, insurers are facing challenges to cater to diverse clientele. Increasingly Indian customers have started considering health insurance partners as extensions of health advisers. It becomes important to understand their psyche and provide tailored solutions with wellness benefits to meet objectives and generate profitable revenue for the company.

Key Result Areas

• Help create a quality pool of providers across the zone within reasonable reach of the customers within minimum reasonable time frame to meet the business requirement.
• Responsible to create comprehensive hospital and allied healthcare network through direct tie ups
• Creating hospital network spread across Districts, Cities and rural locations across India
• Responsible to create network of healthcare providers in accordance to sales strategic expansion and new target locations.
• Drive the commercial negotiations with the providers to ensure the best deal for the end consumer.
• Responsible to analyze claims portfolios of the respective zone and accordingly devise discussion agenda with hospitals
• Managing to minimize Organisational claims spent on payout by means various negotiation parameters like, Volume discount, Early payment discount, Service level discounts and corporate based discounts.
• Doing market research and competitors bench mark pricing, approach provider for agreeing on ABHI packages.
• Target for Better and improvised negotiation with top utilised providers based on disease category
• Allow ABG customers to access quality healthcare at optimum pricing
• Responsible to devise discussion agenda with the providers to get Early Payment Discount
• Negotiating MoU conditions with the provider
• Out Patient Strategy Implementation
• Responsibility to create OPD DRM network of Consultants, Diagnostics chains Pharmacy stores in respective regions

Disclaimer: This job posting and Location has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.