Job Description

Designation:

Assistant Manager

Preference

: Immediate Joiner (Male)

Industry: Insurance /TPA

Roles & Responsibilities :

u Identify and empanel hospitals, clinics, diagnostic centers, and other healthcare providers to join the network.

u Maintain hospital network master with clean data and appropriately flag suspected hospitals

u Evaluate the quality of healthcare providers based on accreditation, facilities, and medical staff credentials.

u Negotiate contracts, package rates and discounts with healthcare providers to ensure competitive pricing while maintaining quality standards.

u Build and maintain strong relationships with hospital administrators, medical directors, and key stakeholders to facilitate seamless cashless claims management

u Coordinate and help cashless team in the events of disputes at the time of admission/discharge of members regarding billing by hospital

u Address and resolve any issues or concerns raised by network providers promptly and professionally.

u Ensure that the network hospitals comply with relevant state & central govt registrations and accreditation requirements.

u Stay updated with changes in healthcare policies and regulations that may impact the network.

u Analyze network performance data and generate reports for management to assess the network's effectiveness and make informed decisions.

u Close coordination with insurers on the network hospital management including empaneling hospitals as per the requirements of insurers.

u Managing the team working for network hospital management across locations.

u Constant monitoring of hospitals claims outstanding and coordinate with respective internal stake holders for payment of claims

u Close coordination with claims team on fraud and abuse control and initiation of appropriate action against hospitals involved in malpractices.

u Assisting Provider Network Management Head in maintaining the provider master in the core application.

Job Types: Full-time, Permanent

Pay: ?30,000.00 - ?35,000.00 per month

Benefits:

Paid sick time Provident Fund
Schedule:

Day shift Fixed shift
Work Location: In person