• Set up, manage and maintain a network of medical service providers to provide cashless service benefit to the members under the managed care schemes.
• Maintain a good rapport with the Medical Specialists, provider managements and other Healthcare service providers. Develop methods, strategies, and tools to improve provider relationships.
• Ensure that appropriate action is taken in response to inquiries by Clients regarding any aspect of service access or compliance.
• Coordinate with the Medical Department with regards to claim processes. Works closely with other departments to assure a smooth coordination of efforts and resources
• Authorize to add and remove the providers from the network. Review contractual agreements with healthcare providers and ensure the contracts are signed by the COO is a timely manner.
• Negotiate contracting and re - contracting process with health care service providers within corporate guidelines to ensure all services provided are cost effective and in accordance to quality standards.
• Supervise and/or conduct presentations and trainings for appointed health care provider staff on administrative software operation, managed care concepts and provide updates on all related procedures in order to ensure awareness of service requirements and policies across the network.
• Updating the Insurance Companies and the internal departments about the changes in the network.
• Review policy manual and network agreements in an on-going basis and provide suitable recommendations.
• Oversees department workflow procedures. Actively participates in cross-functional meetings, participating in office efforts and planning to implement changes, review system set up, and exceed overall efficiency and service objectives.
• Leads the development and continual refinement of policies and procedures, processes, workflows, etc. to achieve ongoing improvements in service delivery, member and provider satisfaction, quality and consistency of customer interactions across product lines.
• Make suggestions with regard to the staffing requirements of the Network Department. Responsible for developing a strong high performing team, overseeing and providing ongoing coaching, mentoring, and skill development opportunities for each member of the team.
• Maintain confidentiality with regard to the information being processed, stored or accessed.
• Completes other projects and duties as assigned.
Job Description :
To ensure customer service and support all operations. To create customer delight at every interaction.
Interacting with external customers and internal customers and addressing their queries, requests and complaints.
Committed TATs are met consistently
Complaints Management- addressing customer complaints at the branch, system updation, coordination with Sales/HUB/ other functions for resolution.
Refunds processing and dispatch
Undelivered policy documents tracking and management.
Maintenance of all files and registers.
New Business Processing:-
Handling end to end New business processing starting from creation of Client id,Case start up, New business login, Follow up for policy issuance, Quality Check
Follow up with HUB for policy issuance of pending cases