Associate Vice President - Health Network

Role:

Zonal Head - Health Network (North & East)

Designation:

Associate Vice President - Health Network

Job Description: Strategic Leadership: • Develop and execute zonal strategy for provider network expansion in alignment with national goals. • Identify opportunities for network growth and improvement in line with market demands and member needs. • Monitor healthcare trends and regulatory developments to adapt network strategies accordingly.

Network Management: • Build and maintain a robust, high-quality network of empaneled providers. • Negotiate contracts with hospitals and providers, focusing on competitive pricing, quality outcomes, and favorable terms. • Oversee provider credentialing, empanelment, and re-evaluation processes.

Stakeholder & Relationship Management: • Act as the primary liaison between the insurer and healthcare providers across the zone. • Handle escalations, disputes, and grievances from network providers and resolve them efficiently. • Drive provider engagement and satisfaction initiatives to ensure strong partnerships.

Operations & Performance Monitoring: • Monitor key metrics including claims ratios, turnaround time, fraud detection, and cost per claim. • Collaborate with claims, fraud control, and customer service teams to ensure seamless service delivery. • Ensure standardization and adherence to SLAs across all regional teams and provider interactions.

Team Leadership: • Lead, mentor, and develop a high-performing zonal provider management team. • Set clear performance targets, monitor progress, and ensure accountability at all levels. • Promote a culture of compliance, transparency, and continuous improvement.

Regulatory & Compliance: • Ensure all provider contracts and engagements comply with IRDAI guidelines and health authority regulations. • Implement and monitor audit mechanisms for provider billing, service quality, and claims practices.

Experience in number of years 10-15 years

Work Experience Experience in health insurance, provider relations, hospital management, or healthcare operations.

Technology Known 1. MS Office 2. Power BI or Tableau 3. Hospital Information Management systems & Provider Portals 4. Familiarity with claims management system.

Key Skills: A. Strong negotiation skills with experience in healthcare contracting and network expansion. B. Solid understanding of regulatory frameworks (IRDAI, NABH, etc.). C. Proven leadership and team management abilities. D. Analytical mindset with experience in claims data analysis and provider performance monitoring. E. Excellent communication and interpersonal skills.

Qualifications Master’s degree in Healthcare Management, Business Administration, or related field (MBA/MPH preferred).

Any specific stream of qualification Bachelors in Medical/Dental/Ayurveda/Homeopathy/Physiotherapy/Nursing preferred