Manager - Provider Network (Indore)

Overview

This leadership position at Aditya Birla Health Insurance Company Ltd within the Financial Services sector is responsible for crafting and executing the Provider Network strategy. The role demands managing relationships with partners, expanding hospital networks nationwide in line with policy distribution, negotiating hospital tariffs, and establishing a preferred provider network with package-based pricing. Additionally, managing outpatient and wellness partners, third-party administrators (TPAs), health claim processes, preventive health management contracts, health checks, and evaluating new health technology partners for customer service delivery are vital. Also oversees the establishment and management of diagnostic center networks across India through aggregator or direct channels.

Key Responsibilities

• Develop and implement strategies for provider network expansion and management across India's health insurance operations.
• Drive partnership management including hospitals, diagnostics centers, pharmacies, consultants, and home care services ensuring reach aligns with business needs.
• Negotiate medical tariffs and contractual agreements to control average claim size and optimize costs.
• Manage vendor relationships including TPAs, wellness service providers, and technology partners.
• Enhance cashless claim utilization and ensure high-quality service delivery through provider training and quality assurance.
• Ensure compliance with regulations and industry standards, including managing ROHINI registrations and fraud prevention controls.
• Lead team development with structured roles, training, and performance management.

Challenges and Market Context

The health insurance industry is highly competitive with nationalized players and multiple private insurers. Expanding market share requires innovative, cost-effective, and tailored solutions suited to diverse customer needs. Provider-driven market dynamics pose challenges in tariff negotiations and maintaining network quality amid fragmented healthcare infrastructure. Digital adoption and system integration are critical for seamless claim adjudication and customer experience.

Organizational Context

Aditya Birla Health Insurance Co. Limited is a joint venture between Aditya Birla Group and MMI Holdings. The company offers unique health insurance products including chronic care and incentivized wellness programs, leveraging extensive digital distribution. The Vice President roles report up to Executive Vice President and Chief Operating Officer within the operations function.

Quantitative Metrics

• Hospital network coverage: Over 11,000 hospitals across more than 1,000 cities (FY 23-24)
• Other providers (diagnostic centers, consultants, pharmacies): Over 7,700 providers spanning 2,300+ cities (FY 23-24)
• TPA and institutional partners: 12 TPAs and 9 institutional partners (FY 23-24)
• Annual health checks and preventive health management contracts volume: Over 24,000 and 6,500 respectively (FY 23-24)
• Claim payouts: Approximately Rs. 364 crore managed in FY 22-23

Additional Information

• Team size within the department is approximately 23 on-roll staff and 4 contractual/part-time members.
• Manages both on-roll and off-roll workforce across broader business units with thousands of employees.
• The role requires extensive coordination with multiple stakeholders to enable a tech-driven and automated claims process.
• Direct reports include zonal managers responsible for regional provider network development and management.