Job Description
Role: Manager – Assistant Manager / Deputy Manager Provider Central Operations
Qualification: Graduation/Post-Graduation
Minimum Experience: 3-5 years, preferably in Provider management (central operations) in Health insurance or General insurance company
Key Responsibilities Area:
• Performance Tracking & MIS Management
• Tracking Hospital Empanelment Vs. Targets
• Tracking Hospital Discount enhancements & packages
• Tracking Cashless : Reimbursement Ratio
• Tracking ACS improvement
• OPD utilization tracking (vendor wise)
• Data management and analysis
• Managing Queries & Grievances
• Publish a Queries & Grievances report every 15 days basis queries received by RMs
• Obtain a Queries & Grievances report from TPA every month
• Entering comments received from RMs for empanelment requests received and closing cases in time.
• Compliance & Governance
• Ensuring display of updated MCHI Network List on websites
• MCHI Hospital Locator Management
• Reconciliation of Network list with the ones getting displayed on TPA websites- monthly
• SOPs creation and necessary modifications (as per requirements)
Annual review of SOPs
Qualification: Graduation/Post-Graduation
Minimum Experience: 3-5 years, preferably in Provider management (central operations) in Health insurance or General insurance company
Key Responsibilities Area:
• Performance Tracking & MIS Management
• Tracking Hospital Empanelment Vs. Targets
• Tracking Hospital Discount enhancements & packages
• Tracking Cashless : Reimbursement Ratio
• Tracking ACS improvement
• OPD utilization tracking (vendor wise)
• Data management and analysis
• Managing Queries & Grievances
• Publish a Queries & Grievances report every 15 days basis queries received by RMs
• Obtain a Queries & Grievances report from TPA every month
• Entering comments received from RMs for empanelment requests received and closing cases in time.
• Compliance & Governance
• Ensuring display of updated MCHI Network List on websites
• MCHI Hospital Locator Management
• Reconciliation of Network list with the ones getting displayed on TPA websites- monthly
• SOPs creation and necessary modifications (as per requirements)
Annual review of SOPs
💡 Quick Summary
Seeking a career-building opportunity? The Provider Network Management position is now open for candidates interested in the MIS Executive sector. This role in Mumbai offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in MIS Executive is a plus.
