Role Summary

The role is responsible for managing and expanding the provider (hospital) network through empanelment, tariff negotiations, compliance, and process audits. The Manager ensures smooth coordination between hospitals, internal teams, and clients to improve turnaround time (TAT), control claim leakages, and strengthen the overall provider network. The position also supports IRDA initiatives such as Cashless Everywhere.

Key Responsibilities

1. Provider Network Management

• Empanel/de-panel hospitals and expand the network, PAN India.
• Meet hospital owners/admins and ensure agreement renewals & documentation.

2. Tariff Negotiation & Cost Control

• Negotiate tariffs and discounts.
• Reduce claim costs and control claim leakages.

3. Audit & Fraud Control

• Audit hospital bills and processes.
• Identify overcharging and prevent fraud.

4. Team Leadership

• Handle a PAN India team, track performance, and meet targets.

5. Interdepartmental Coordination

• Work with Claims, Fraud Control, Medical, and Customer Service for smooth operations.

6. Regulatory (IRDA) Compliance

• Support “Cashless Everywhere” and ensure hospitals follow regulatory guidelines.

Skills & Competencies

• Strong experience in provider network expansion, empanelment & de-panelment.
• Hands-on experience in tariff negotiation, discount savings, and hospital visits.
• High integrity; strong understanding of fraud indicators and ethical practices.
• Comfortable onboarding 8–10 hospitals per day when required.
• Knowledge of legal documents, contracts, and compliance.
• Team handling ability with a PAN India distributed team.
• Strong communication, relationship building & field coordination skills.
• Willingness to travel extensively PAN India.