Lead OPD Claims – Healthcare Network Management

About the role

The Lead OPD Claims role is responsible for building and managing Aditya Birla Health Insurance’s network of hospitals, clinicians and other healthcare providers within a defined region. The position ensures that customers have seamless, cash‑less access to high‑quality, cost‑effective care and drives the overall performance of the provider network.

Key responsibilities

• Develop, maintain and expand the OPD provider network across the assigned geographical area.
• Negotiate new contracts and manage existing agreements with hospitals and clinicians to secure cash‑less settlement and optimal service quality.
• Act as the primary point of contact for all network providers, handling relationship management, issue resolution and performance monitoring.
• Collaborate with Customer Services, Operations and other business units to ensure timely delivery of services to policyholders.
• Analyse market dynamics, identify new segments and propose strategic initiatives to increase market share and profitability.
• Monitor compliance with contractual terms and regulatory requirements.

Required profile

• Proven experience in healthcare provider network management or claims operations, preferably in health insurance.
• Strong negotiation and relationship‑building capabilities.
• Excellent understanding of the Indian health insurance market and OPD claim processes.
• Ability to work cross‑functionally and influence internal stakeholders.
• Analytical mindset with a focus on data‑driven decision making.

Required skills