Lead - Provider Network

About Our Client

The hiring company is the insurance arm of a leading conglomerate across the country.

Job Description

1. Network Strategy & Digital Transformation:

● Network Development & Expansion: Lead the design and execution of strategies to expand and enhance the P&C provider network, integrating digital technologies for the optimization.

● Develop and execute the organization's strategic network plan to ensure the provider network aligns with business goals, member needs, and regulatory requirements.

● Continuously assess the network to identify opportunities for expansion, optimization, and improvement in both geographic and specialty coverage.

● Analyze market trends, competitor networks, and demographic data to make data-driven decisions about network composition and growth.

● Digital Tools Integration: Drive the adoption of advanced digital tools (, claims automation, predictive analytics, cloud-based platforms) to improve network operations, provider management, and care coordination. This includes leveraging data analytics to optimize provider performance and identify trends for network improvement.

2. Vendor & Provider Relationship Management with Digital Support:

● Lead negotiations and long-term relationships with service providers (garages, contractors, lawyers, medical assessors, etc.).

● Manage end-to-end procurement lifecycle: RFI/RFP, contracting, onboarding, and performance management.

● Oversee SLAs, compliance, and service quality audits.

● Foster strategic partnerships and alliances that enhance network value and scalability.

3. Operational Efficiency & Data-Driven Network Optimization:

● Network Performance Monitoring: Leverage advanced data analytics and AI to monitor network performance, identifying gaps in care, inefficiencies, or opportunities to enhance member experience.

● Lead digital integration of the service network (, APIs for FNOL, digital repair tracking, e-invoicing).

● Collaborate with product and IT teams to automate claims workflows using provider platforms.

● Evaluate and implement insurtech partnerships for virtual assessments, photo estimation, and AI-assisted repair decisions.

● Drive digital transformation of provider interfaces and customer self-service touchpoints.

4. Compliance, Regulatory, and Digital Risk Management:

● Regulatory Compliance: Ensure provider agreements and operations comply with local regulatory, legal, and data protection requirements.

● Digital Security & Privacy: Work closely with IT and cybersecurity teams to ensure data privacy and security protocols are followed

● Risk Management: Use data analytics to predict and manage network risks, including provider performance, member access, and fraud prevention. Leverage digital tools for fraud detection, such as AI-driven claims analysis, to reduce fraud in the network.

● Represent the company in external audits or regulator engagements as required.

● Ensure ethical and fair practices across the network.

5. Performance, Financial & Cost Control with Digital Insights:

● Financial Strategy: Leverage digital analytics to manage and optimize network costs. Use predictive modeling and cost-analysis tools to identify opportunities for cost savings while maintaining high-quality care.

● Cost-Effective Provider Networks: Implement strategies to reduce unnecessary hospital readmissions and emergency room visits through enhanced digital care coordination, predictive analytics, and remote patient monitoring, driving down costs.

● Monitor provider performance using real-time dashboards and analytics (, repair cycle time, cost per claim, customer satisfaction).

● Identify and mitigate leakage or fraud risks within the network.

● Develop incentive models to drive provider efficiency and alignment with customer Team Leadership & Digital Skills Development:

● Lead the Network Management Team: Provide leadership, mentorship, and coaching to the network management team, fostering a culture of innovation, digital literacy, and continuous improvement.

● Develop Digital Competencies: Ensure that the network management team is skilled in using digital tools, platforms, and data analytics. Provide ongoing training on digital technologies to ensure team members stay up-to-date with industry advancements.

The Successful Applicant

A successful Lead - Provider Network should have:

● Deep understanding of P&C N/w processes (FNOL to settlement).

● Familiarity with the systems, digital workflow tools, and provider portals.

● Strong data analytics skills; experience with BI dashboards (, Power BI, Qlik).

● Knowledge of repair estimating tools (Audatex, Mitchell, etc.) and telematics data is a plus.

● Experience managing budgets, negotiating contracts, and identifying cost-saving opportunities through the strategic use of digital solutions.

● Commercial acumen in vendor contracting and service pricing.

● Change management and cross-functional collaboration capabilities.