Position Manager – Central Operations and Provider Risk Manager Location Delhi ( NOC or Hospital location )
Department Healthcare Purchase Function Health Risk Management
Reporting to Head – Healthcare Purchase Band M6
Number of opening 1 JD Code
(Describe the primary function and purpose of this role)
The Health Risk Management team is responsible for managing the total Max Bupa’s healthcare spend through healthcare provider network of hospitals, OPD clinics/ doctors, Diagnostic centre, healthcare vendors and third party administrators ensuring customers are able to readily access high quality, cost effective services at the point of need.
The job holder will be primarily responsible for managing central operations for healthcare purchase team which include managing internal stakeholders and cross departmental initiatives / projects relating to healthcare providers. Key deliverables include data analysis, audit and risk management, managing SOP and process level initiatives (lean and cost effective processes), Project management support to the Healthcare purchase team as directed by the Head of Healthcare Purchase / Health Risk Management.
A qualified candidate should have minimum 7 -8 years of experience in health insurance Claim process and data analysis and MIS
(Mention a detailed description of key areas of focus, essential functions and primary responsibilities required to be performed by the incumbent to achieve business objectives) Key Measures of Performance
(Describe the major performance assessing criteria and expectations from the role)
Develop and implement data analyses, data collection and other strategies that aids negotiation strategies and process efficiencies
Identify, analyze and interpret trends and pattern from the data
Track MOS defined in Annual operating plan and create insights from data to refine strategies to meet MOS.
Work with management to prioritize the business needs.
Locate and define new process improvement opportunities
Project management support on key projects under Healthcare Purchase department
Healthcare Provider administration and contract management
Liaise with IRDAI on ROHINI project
Audit data, processes and healthcare providers. Share audit reports and insights of improvement
Work with cross department teams to implement process improvements.
Predefined KRA as defined in the annual operating plan. KRAs will include but are not limited to:
Share insights from past data to refine negotiation strategies
Create performance reports (department/ healthcare providers)
Track project timeline and deliver as per defined MOS
Timely submission of all MIS and dashboard to key stakeholders
Key Relationships (Internal / External)
(Mention the set of key internal and external stakeholders)
Sales, Operations, Products, HCP,
Finance, Grievance Team, Hospital authorities, Max Bupa Customers and prospective clients, Health professionals and medical practitioners and clinicians,
Preferred Skill Set
(Describe the nature and level of key skill required\preferred to perform the jobs e.g. interpersonal skills, problem solving ability and business expertise)
Good command on English, self starter and hold interpersonal skills.
Knowledge of ICD and medical terminology
Knowledge to export, transform and load data and create valuable insights for effective business operation.
Focused outlook for achieving results
Ability to prioritize and handle multiple tasks.
Ability to self-motivate and take responsibility for personal growth and development.
Ability to make considered business decisions based on explicit and implicit data and information.
Used to working in a high pressure environment and meeting challenging service standards.
Domain knowledge – Insurance industry and Healthcare Industry
Minimum Qualification Minimum Experience
Medical degree/Medical graduate level qualification ; or
Professional general or health care management or hospital administration diploma / degree will be an added advantage
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