Manager- Central Operations & Network Management - Healthcare Insurance

JOB SUMMARY:

The job holder is a key member of team and responsible for managing the Niva Bupa provider management operations.

The job holder will own end-to end provider management operations including provider grievance. This will include the collaboration with all internal & external ternal stakeholders.

The job holder will work closely with all stockholders to improve the process in accordance with regulations.

The job holder will be primarily responsible for managing central operations for healthcare purchase team which include managing internal stakeholders and cross departmental initiatives / projects relating to healthcare providers. Key deliverables include data analysis, audit and risk management, managing SOP and process level initiatives (lean and cost effective processes), Project management support to the Healthcare purchase team as directed by the Head of Healthcare Purchase / Health Risk Management.

A qualified candidate should have minimum 7 -8 years of experience in health insurance claim process, data analysis and MIS.

- Development of policy guidelines for the empanelment of new servicer providers.

- Negotiation and empanelment of different types of providers

- Investigate, evaluate, and post applying technical knowledge monitor the performance of all the provider

- Resolve complex negotiations and terms with the network providers and get the best deal for the organization

- To monitor and control error rates and consistency in processing.

- To monitor and appraise performance of providers.

- To monitor provider complaints, trend and timely resolution.