Magma HDI General Insurance
3 weeks ago
Key Responsibilities:
- Provider Network Management: Build and manage a high-quality and cost-efficient network of healthcare providers, ensuring the right geographical spread to serve our members effectively.
- Contracting & Negotiation: Lead provider contracting efforts, including negotiations for quality and cost-efficient services during both empanelment and rate-revisions. You will also be responsible for regular case management negotiations.
- Operational Oversight: Manage all end-to-end Provider Network operations in the zone, ensuring smooth and efficient processes.
- Fraud, Waste & Abuse (FWA) Prevention: Proactively identify potential leakages and implement measures to prevent FWA, protecting company assets and ensuring fair claims practices.
- Cost Control & Monitoring: Maintain close monitoring and control of ACS (Average Cost per Stay), aiming for cost efficiency without compromising on quality of care.
- Due Diligence & Agreements: Be hands-on with the provider due diligence process and execute bi-partite and tripartite agreements.
- Cross-functional Coordination: Collaborate effectively with internal teams such as sales, operations, and underwriting to ensure a seamless service experience for all stakeholders.
- Industry Awareness: Stay informed about the latest trends and developments in the health insurance and healthcare sector and a deep understanding of regulatory guidelines.
Specialized Skills & Competencies:
- Hands-on with Provider Network Management: Proven experience in building, managing, and optimizing a network of healthcare providers.
- Strong Relationships: Established relationships with corporate hospitals and key stakeholders in the healthcare ecosystem.
- Regulatory Understanding: A solid grasp of regulatory guidelines governing the health insurance sector.
- Industry Awareness: A keen awareness of the latest trends, technological advancements, and policy changes in health insurance and healthcare.
(ref:iimjobs.com)
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