Senior Manager/Manager - Hospital Network Management

We are looking for a dynamic and experienced professional to strengthen our Hospital Network function. The role will be responsible for expanding, managing, and optimizing the healthcare provider network while ensuring quality, compliance, and cost efficiency. Key Responsibilities • Define and streamline the empanelment process and finalize communication materials. • Identify and empanel hospitals, clinics, diagnostic centers, and other healthcare providers. • Define hospital categories, grading framework, and appropriate mapping. • Maintain the hospital network master with clean data and properly flag suspected hospitals. • Analyze market trends, insurer/client requirements, and geographical spread to identify network gaps. • Evaluate healthcare providers based on accreditation, infrastructure, and medical staff credentials. • Negotiate contracts, package rates, and discounts with providers to ensure competitive pricing while maintaining quality. • Collaborate with Legal and Compliance teams to draft and finalize provider agreements. • Build and maintain strong relationships with hospital administrators, medical directors, and key stakeholders to support seamless cashless claims management. • Coordinate with the cashless team during admission/discharge disputes related to hospital billing. • Address and resolve issues raised by network providers promptly and professionally. • Implement and monitor performance metrics for network hospitals. • Continuously assess network adequacy and identify expansion or optimization opportunities. • Work closely with the Business Development team to align network growth with organizational strategy. • Ensure network hospitals comply with applicable State and Central Government registrations and accreditation requirements. • Stay updated on healthcare policies and regulatory changes impacting the network. • Analyze network performance data and generate MIS/reporting for management review. • Closely coordinate with insurers regarding network requirements and empanelment. • Lead and manage the hospital network team across locations. • Define guidelines for hospital visits and ensure proper recording and maintenance. • Monitor hospital claim outstanding and coordinate internally for timely claim payments. • Ensure adherence to IRDAI guidelines with respect to de-empanelment processes. • Coordinate with the Claims team on fraud and abuse control and initiate action against malpracticing hospitals. • Benchmark network strength and pricing against competitors and implement improvement measures. Eligibility Criteria Experience: • 7–14 years of relevant experience in Hospital Network / Provider Management in TPA, Insurance, or Healthcare industry. • Prior experience in TPA/Health Insurance provider network management is strongly preferred. Education: • Graduate in any discipline (Healthcare/Management preferred) • MBA/PGDM in Healthcare or Insurance will be an added advantage. Job Types: Full-time, Permanent Pay: ₹50,000.00 - ₹80,000.00 per month Benefits: • Cell phone reimbursement • Provident Fund Work Location: In person