Networking Executive – Insurance

Job Summary

The Networking Executive – Insurance will be responsible for building, developing, and maintaining strong relationships with hospitals, healthcare providers, insurance companies, and Third-Party Administrators (TPAs). The role involves hospital empanelment, provider onboarding, documentation, coordination, relationship management, issue resolution, and network expansion to support smooth insurance operations.

Key Responsibilities

1. Provider Network Management

• Develop and maintain professional relationships with hospitals, clinics, insurance companies, and TPAs.
• Identify potential hospitals and healthcare providers for network expansion.
• Coordinate the onboarding and empanelment of new healthcare providers.
• Maintain an updated database of hospitals, insurers, TPAs, and provider contacts.
• Ensure provider details, agreements, and contact information are accurate and updated.

2. Hospital Empanelment & Credentialing

• Coordinate hospital empanelment with insurance companies and TPAs.
• Collect and verify required hospital and provider documents.
• Follow up with hospitals, insurers, and TPAs regarding empanelment applications.
• Track empanelment status and ensure timely completion of documentation.
• Support renewal, re-credentialing, and agreement renewal processes.

3. Relationship Management

• Act as the primary point of contact for assigned hospitals and insurance partners.
• Conduct regular follow-ups and meetings with network partners.
• Understand and address concerns raised by hospitals, insurers, and TPAs.
• Maintain strong and professional relationships with key stakeholders.
• Ensure timely communication and effective partner support.

4. Coordination & Issue Resolution

• Coordinate with internal teams such as Insurance Operations, Claims, Billing, Accounts, and Management.
• Facilitate communication between hospitals, insurance companies, and TPAs.
• Assist in resolving operational and documentation-related issues.
• Follow up on pending cases, approvals, agreements, and service-related concerns.
• Support smooth implementation of insurance processes and network initiatives.

5. Documentation & Compliance

• Maintain proper records of empanelment documents, agreements, renewals, and correspondence.
• Ensure documentation is complete, accurate, and properly maintained.
• Support internal and external audits by providing required documents and reports.
• Follow organizational policies, procedures, and applicable healthcare insurance requirements.

6. Reporting & MIS

• Prepare regular MIS reports related to hospital empanelment and network activities.
• Track new provider additions, renewals, pending applications, and partner issues.
• Maintain accurate records of network performance and activities.
• Provide regular updates to the reporting manager.

7. Business Development & Network Expansion

• Identify potential hospitals and healthcare providers for network expansion.
• Conduct hospital visits and meetings as required.
• Assist in developing new provider partnerships.
• Support management in partnership discussions and negotiations.
• Explore opportunities to strengthen the organization's healthcare provider network.

Qualifications

• Bachelor's degree in Hospital Administration, Healthcare Management, Business Administration, Marketing, or a related field.
• MBA/MHA or relevant postgraduate qualification will be an added advantage.

Experience

• 2–5 years of experience in hospital networking, insurance operations, hospital empanelment, TPA coordination, healthcare relationship management, or business development.
• Experience working with hospitals, insurance companies, or TPAs is preferred.

Required Skills

• Good understanding of health insurance and TPA operations.
• Knowledge of hospital empanelment and provider networking.
• Strong communication and interpersonal skills.
• Good negotiation and relationship-management abilities.
• Strong coordination and follow-up skills.
• Problem-solving and decision-making abilities.
• Good knowledge of MS Office, Excel, email, and CRM/HIS systems.
• Ability to manage multiple stakeholders and meet deadlines.
• Willingness to travel for hospital visits and partner meetings when required.

Key Performance Indicators (KPIs)

• Number of new hospitals/providers successfully empanelled.
• Empanelment completion and turnaround time.
• Network expansion and provider coverage.
• Contract and renewal completion rate.
• Timely resolution of partner-related issues.
• Accuracy and completeness of provider documentation.
• Partner relationship and engagement effectiveness.
• Timeliness and accuracy of MIS reports.
• Compliance with organizational processes and requirements.

Job Requirements

• Strong professional communication and follow-up skills.
• Ability to build long-term relationships with hospitals and insurance stakeholders.
• Ability to work independently as well as part of a team.
• Willingness to travel within the assigned territory.
• Target-oriented and organized approach to work.

Work Location: In person

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