PLANNING AND IMPLEMENTING:
- Set-up robust provider network which provides quality care and drives efficiency through effective claims management.
- Oversee Claims analysis and hospital performance reporting.
- Set-up Risk investigation network to deter frauds
- Monitor and control average claim value.
-Personally handle top end service providers in the market.
- Responsible for developing both annual and monthly objectives for Networking in coordination with the Organisation’s objective.
- Strategic planning for network expansion.
- Responsible for creating network and enhance brand visibility
- Perform process re-engineering and ensure seamless delivery to the consumer with minimal grievances
- Maintaining and publishing dashboard and insights for the management/leadership team.
CASE AUDITS/CASE MANGEMENT:
- Specific High value claim audits.
- Medical high value audits of hospitals and recoveries whenever indicated.
- Regularly assess risk by monitoring key trends, behaviours, claims experience and fraud trends
- Medical audit and reporting to the management team.
-Accountable for team handling and team performance.
-conduct review meetings and establish action plans
-Plan and hold meetings with hospitals.
3. Qualifications and Experience required for the position
• Medical practitioner with relevant qlf in Health Administration/Hospital management
• Total Experience of 08-12 yrs in healthcare or insurance industry
• In-depth Understanding of risk management and should have handled Underwriting /Claims and provider management and networking.
• Sound Analytical skills
• Excellent communication and negotiation Skills
• Has handled managerial role for 2-4 years with direct reports to the leadership team
4. Behaviours/ Competencies
• High on integrity and ethics
• Proactive, agile and highly responsive towards achieving goals - leveraging key strengths and capitalizing on opportunities with a keen sense of urgency
• Strong interpersonal skills, able to successfully build and maintain networking relationships (both formal and informal)
• Continuously strives for excellence and improvement
• Convincing and implementing ability.