Provider Network

2 days ago

Anna Nagar Chennai Tamil Nadu, India Link-K Insurance TPA Private Limited Full time

**Greeting From Link-K Insurance TPA Pvt Ltd**

We are hiring **Provider Network Management**at our **Chennai Corporate Office.**

**Job Role**:Provider Network Management

**Industry**:TPA/Health Insurance

**Location**:Chennai, Tamil Nadu

**Experience**: 5 Year to 8 Years

**Qualification**:Graduate in any discipline

**Roles & Responsibilities**:

- Define empanelment process, finalizing communication material
- Identify and empanel hospitals, clinics, diagnostic centers, and other healthcare providers to join the network.
- Defining categories of hospitals, grading and appropriately mapping
- Maintain hospital network master with clean data and appropriately flag suspected hospitals
- Analyze market trends, insurance company and client requirements and geographical spread to identify potential gaps in the network.
- Evaluate the quality of healthcare providers based on accreditation, facilities, and medical staff credentials.
- Negotiate contracts, package rates and discounts with healthcare providers to ensure competitive pricing while maintaining quality standards.
- Collaborate with legal and compliance teams to draft and finalize contracts that meet regulatory requirements and protect the interests of the TPA and its clients.
- Build and maintain strong relationships with hospital administrators, medical directors, and key stakeholders to facilitate seamless cashless claims management
- Coordinate and help cashless team in the events of disputes at the time of admission/discharge of members regarding billing by hospital
- Address and resolve any issues or concerns raised by network providers promptly and professionally.
- Implement performance metrics to assess the efficiency and quality of services provided by network hospitals.
- Continuously assess the network's adequacy and identify opportunities for expansion or optimization.
- Collaborate with the business development team to align network growth with the TPA's strategic objectives and market demands.
- Ensure that the network hospitals comply with relevant state & central govt registrations and accreditation requirements.
- Stay updated with changes in healthcare policies and regulations that may impact the network.
- Analyze network performance data and generate reports for management to assess the network's effectiveness and make informed decisions.
- Close coordination with insurers on the network hospital management including empaneling hospitals as per the requirements of insurers.
- Managing the team working for network hospital management across locations.
- Defining the guidelines for hospitals visits and monitoring recording and maintenance of hospital visits
- Constant monitoring of hospitals claims outstanding and coordinate with respective internal stake holders for payment of claims
- Adhering to IRDAI guidelines w r t to de-empanelment process.
- Close coordination with claims team on fraud and abuse control and initiation of appropriate action against hospitals involved in malpractices.
- Constantly comparing the network hospitals count and rates with competition and taking appropriate measures to be best in the industry.

**Important Note**:

- **Health Insurance / TPA** Profile only eligible.

**Job Types**: Full-time, Permanent

Pay: ₹55,000.00 - ₹65,000.00 per month

**Benefits**:

- Cell phone reimbursement
- Paid sick time
- Provident Fund

Work Location: In person

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