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22 Prudential plc Jobs
Zonal Manager- Provider Network
10-12 years
Kolkata, Mumbai, New Delhi + 4 more
1 vacancy
Zonal Manager- Provider Network
Prudential plc
posted 1mon ago
Job Role Insights
Flexible timing
Key skills for the job
Job Description
- Design, implement, launch, and manage a robust provider network management function at zonal level by creating negotiation framework, processes, and systems factoring in provider and customer experience deliverables.
- Lead in building trust and long-term relationships with the network hospitals for creating competitive advantage for Prudential Health India.
- Develop and evolve detailed standard operating procedures for comprehensive and seamless functioning of Network function to enable Claims management process
- Collaborate with functions including but not limited to Claims, Technology, Product & Actuarial, Compliance, Risk Management, and Finance; represent Claims Management Function in cross-functional implementations
- Identify Healthcare Service provider partners include Hospitals, Doctors, Diagnostic centers / vision, and dental centers / home care treatment providers /allied medical service providers, and other partners that will add value in services for Prudential policy holders.
- Manage vendors/ partners and TPAs to ensure a delightful customer experience while ensuring process rigor and SLAs
- Lead, manage, and develop your team, establish clear responsibilities for all team members build a strong culture of accountability and performance, manage training & development of team members; enable teams with coaching & structured skills to scale with business & perform effectively
- Create and develop digital hospital (Provider) onboarding journey and agreements and maintain relationship, continue analyzing provider and competitor landscape & Market intelligence
- Engaging provider network through effective communication, Data led analytics aka utilization patterns, recognition and continuous training interactions.
- Lead for creating preferred set of hospitals for executing differentiated services for PHI customers.
- Lead tariff digitization process to enable claims process automation and efficient outcomes
- Continuous monitoring of performance and utilization patterns to generate feedback loop and data analytics.
- Lead in created automated processes including Payment reconciliation, statements and MISs for the providers.
- Lead in creating fraud, waste and abuse framework, case management negotiations processes with Network hospitals.
- Lead in effectively repricing and re-negotiations of the Tariff / Packages / Discounts with healthcare providers
You could be the right candidate if you
- Have a degree or a management degree (healthcare management is preferred)
- Have 8-10yrs exp in Hospital/Insurance industry with at least 5+ years experience in leading provider network teams
- Have experience with developing provider networks from a scratch
- Able to make quick decisions and have good judgment and analytical skills
- Have an excellent verbal and written communication skills and strong negotiation skills.
- Always open to embracing change and be able to manage it
- Passionate about building highly engaged teams
This could be the gig for you if you
- Are passionate about consumer behavior and culture; enjoy spending time with customers/providers to understand what they really want. Have an attentive ear listen to new ideas.
- Thrive in environments that celebrate co-creation and collaboration
- Are passionate about leveraging digital tools to transform customer experience
- Like to work in a culture where everyone can see what others are doing
- Take help from others when stuck and encourage others when there are setbacks
- Take full responsibility for your team s contribution while thinking wing to wing across the organization; to solve for the customer
Employment Type: Full Time, Permanent
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based on 5 employees
Flexible timing
Monday to Friday
Within country
Day Shift
Prudential plc Benefits
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