Provider Management & System Design

Responsible for defining and optimizing processes for hospital onboarding, accreditation, tariff management, and performance monitoring of providers within a new system., * Manage the full provider lifecycle: onboarding, contracting, tariff management, delisting

• Define master data structure and attributes for system design
• Design approval workflows for new hospitals and tariff changes
• Specify interfaces to claims processing, fraud prevention, and financial settlement
• Define data capture for IRDAI and internal reporting (e.g., cashless network strength)
• Participate in testing of provider portal and integration with TPAs

• 4-5 years of experience in provider network management and system design
• Hands-on experience with provider contract management tools or portals
• Strong analytical and process mapping skills
• Knowledge of ICD/DRG codes, tariffs, and IRDAI disclosure requirements
• Ability to translate business process logic into system requirements
• Experience in "As-Is" / "To-Be" analysis, gap analysis, and workflow design
• Collaboration with IT development and QA teams on core insurance systems
• Deep understanding of IRDAI regulations, especially SLAs in provider management
• Excellent documentation, analysis, and stakeholder management skills

Typical Background:

Degree in healthcare management or insurance; prior involvement in core system implementations or provider platform development in India.