Tpa Medical Insurance jobs

JOB DESCRIPTION
Manager – Medical Network Profile
Underwriting Department | Medical Network Channel Management

Job TitleManager – Medical Network ProfileDepartmentUnderwritingSub-FunctionMedical Network TPA GovernanceReports ToChief Manager Medical NetworkEmployment TypeFull-TimeLocationMumbai
ROLE PURPOSE
The Manager – Medical Network Profile is a pivotal leadership role within the Underwriting Department, responsible for overseeing the end-to-end performance of the medical network team. The role holder will drive channel performance management, enforce TPA governance frameworks, and deliver actionable insights through advanced dashboarding and reporting. This position demands a strategic thinker with strong analytical capabilities, coupled with exceptional interpersonal and communication skills to influence stakeholders at all levels.
KEY RESPONSIBILITIES
Channel Performance Management
Monitor, evaluate, and optimize the performance of all channels to ensure alignment with business targets and underwriting objectives.
Develop and implement channel-specific KPIs, benchmarks, and performance scorecards.
Identify performance gaps and collaborate with internal and external stakeholders to implement corrective action plans.
Analyze channel trends and provide strategic recommendations to enhance Channel efficiency and cost-effectiveness for medical network
Track cost trends, utilization patterns, and network penetration metrics on a regular basis.
TPA Governance
Establish, manage, and continuously improve the TPA (Third Party Administrator) governance framework in line with regulatory and company standards.
Conduct regular audits, reviews, and assessments of TPA performance against contractual SLAs and compliance obligations.
Liaise with TPAs to resolve escalations, disputes, and operational challenges in a timely manner.
Ensure proper documentation, reporting, and escalation protocols are maintained across all TPA engagements.
Collaborate with legal, compliance, operations, UW IT teams to ensure TPAs adhere to company policies and regulatory requirements.
Dashboarding Reporting
Design, develop, and maintain comprehensive dashboards that provide real-time visibility into Medical Network Team performance, UW analytics, and channel metrics.
Generate periodic management reports (weekly, monthly, quarterly) tailored to different stakeholder audiences including senior leadership.
Translate complex data sets into clear, concise, and actionable insights for decision-making.
Collaborate with IT and data analytics teams to enhance reporting infrastructure and automation capabilities.
Ensure data accuracy, integrity, and consistency across all reporting tools and platforms.
People Management
Lead, coach, and develop a team, fostering a high-performance culture.
Set clear objectives, conduct regular performance reviews, and provide continuous feedback and development opportunities.
Drive team engagement, motivation, and retention through effective leadership and a collaborative working environment.
Identify talent gaps and support recruitment, onboarding, and succession planning efforts.
Promote cross-functional collaboration and knowledge sharing across departments.
QUALIFICATIONS EXPERIENCE
Bachelor's degreein Science , Commerce, Business Administration, , Finance, or a related field; Master's degree is an advantage.
Minimum 8-10 years of progressive experience in Insurance, insurance, or managed care, with at least 2-3 years in a management or supervisory capacity.
Demonstrated experience in TPA management governance, and channel performance optimization.
Strong proficiency in excel, and MS suites
In-depth understanding of medical network operations, Life / Health Insurance operations
CORE COMPETENCIES
Technical CompetenciesBehavioural CompetenciesChannel TPA Performance Management
TPA Governance Compliance
Reporting, MIS Dashboarding
Underwriting Principles
Strategic Reporting Insights
People Skills Team Leadership
Effective Communication
Executive Presentation Skills
Stakeholder Management
Problem-Solving Decision-Making
PEOPLE, COMMUNICATION PRESENTATION SKILLS
The role demands an individual who excels in building relationships and driving influence across the organization:
People Skills: Proven ability to lead diverse teams, manage performance constructively, and cultivate a collaborative and inclusive team environment.
Communication Skills: Excellent written and verbal communication skills with the ability to convey complex technical and analytical information to non-technical audiences clearly and effectively.
Presentation Skills: Strong ability to design and deliver compelling, data-driven presentations to senior management, executive committees, and external stakeholders including TPAs and network partners.
Negotiation Influencing: Ability to negotiate with TPAs and channel partners to drive value and ensure adherence to governance standards.
Emotional Intelligence: High degree of self-awareness and empathy, enabling effective conflict resolution and team motivation.
KEY RELATIONSHIPS
Internal: Underwriting, Issuance , Finance, Compliance, IT Data Analytics, Sales, and Senior Leadership Team.
External: Third Party Administrators (TPAs),