Zonal Manager- Provider Network

Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

At Prudential India Health, we are on a mission to make Indians healthier, while bridging the health protection gap. We are a Zero to One team, committed to build journeys that will truly empathize with the customer and offer a differentiated, bespoke Prudential experience.

To partner us in this mission, we are looking for a talented…

As a Zonal Manager of Provider Network & Operations, your typical week might include the following

• Design, implement, launch, and manage a robust provider network management function at zonal level by creating negotiation framework, processes, and systems factoring in provider and customer experience deliverables.
• Lead in building trust and long-term relationships with the network hospitals for creating competitive advantage for Prudential Health India.
• Develop and evolve detailed standard operating procedures for comprehensive and seamless functioning of Network function to enable Claims management process
• Collaborate with functions including but not limited to Claims, Technology, Product & Actuarial, Compliance, Risk Management, and Finance; represent Claims Management Function in cross-functional implementations
• Identify Healthcare Service provider partners include Hospitals, Doctors, Diagnostic centers / vision, and dental centers / home care treatment providers /allied medical service providers, and other partners that will add value in services for Prudential policy holders.
• Manage vendors/ partners and TPAs to ensure a delightful customer experience while ensuring process rigor and SLAs
• Lead, manage, and develop your team, establish clear responsibilities for all team members build a strong culture of accountability and performance, manage training & development of team members; enable teams with coaching & structured skills to scale with business & perform effectively
• Create and develop digital hospital (Provider) onboarding journey and agreements and maintain relationship, continue analyzing provider and competitor landscape & Market intelligence
• Engaging provider network through effective communication, Data led analytics aka utilization patterns, recognition and continuous training interactions.
• Lead for creating preferred set of hospitals for executing differentiated services for PHI customers.
• Lead tariff digitization process to enable claims process automation and efficient outcomes
• Continuous monitoring of performance and utilization patterns to generate feedback loop and data analytics.
• Lead in created automated processes including Payment reconciliation, statements and MISs for the providers.
• Lead in creating fraud, waste and abuse framework, case management negotiations processes with Network hospitals.
• Lead in effectively repricing and re-negotiations of the Tariff / Packages / Discounts with healthcare providers

You could be the right candidate if you

• Have a degree or a management degree (healthcare management is preferred)
• Have 8-10yrs exp in Hospital/Insurance industry with at least 5+ years’ experience in leading provider network teams
• Have experience with developing provider networks from a scratch
• Able to make quick decisions and have good judgment and analytical skills
• Have an excellent verbal and written communication skills and strong negotiation skills.
• Always open to embracing change and be able to manage it
• Passionate about building highly engaged teams

This could be the gig for you if you…

• Are passionate about consumer behavior and culture; enjoy spending time with customers/providers to understand what they really want. Have an attentive ear listen to new ideas.
• Thrive in environments that celebrate co-creation and collaboration
• Are passionate about leveraging digital tools to transform customer experience
• Like to work in a culture where everyone can see what others are doing
• Take help from others when stuck and encourage others when there are setbacks
• Take full responsibility for your team’s contribution while thinking wing to wing across the organization; to solve for the customer

What can make you extra special

• It’s great if you have already read books like Never Split the difference: Negotiating as if your life depended on it.
• You have real stories to tell about how your team and you challenged convention and took the path less travelled.
• We are keen to listen to your story; doesn’t matter if you tell these stories with a sigh or with excitement. We respect both versions. Truly.

Location: Mumbai

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.