Key Responsibilities
1. Provider Empanelment & Contracting
• Identify, approach, and empanel new hospitals, clinics, diagnostic centres, and specialty providers in line with business requirements.
• Negotiate tariffs, package rates, and cashless agreements as per company policy.
• Ensure timely renewal of contracts and rate revisions.
2. Network Expansion & Gap Analysis
• Conduct periodic gap analysis to ensure adequate geographic and specialty coverage for insured members.
• Onboard strategic providers in underserved locations to improve network adequacy.
3. Provider Relations & Servicing
• Act as the point of contact for provider queries related to cashless claims, pre-authorisations, reimbursement, and operational escalations.
• Conduct provider training and orientation sessions on processes, documentation, and claims protocols.
• Resolve provider grievances promptly and maintain strong long-term partnerships.
4. Compliance & Quality
• Ensure all provider contracts and processes adhere to IRDAI regulations and internal audit standards.
• Verify hospital infrastructure and quality standards before empanelment.
• Monitor provider performance (claims turnaround, denial rates, fraud checks).
5. Data & Reporting
• Maintain updated provider data in network management systems.
• Generate MIS reports on network adequacy, empanelment status, utilisation trends, and provider performance.
• Support management in audits, reviews, and regulatory submissions.