Objective

To establish the healthcare group as the preferred partner for payors and patients by creating an efficient Business Development model. The Head Payor will be responsible for building strategic relationships, streamlining engagement practices, and ensuring that the group is recognized for best-in-class clinical and operational outcomes while delivering a seamless experience to patients and insurers.

Scope

This role will lead the strategic payor engagement roadmap across the hospital chain, ensuring growth in revenue, market share, and patient trust. The timeline for execution will be defined based on a thorough evaluation of current engagement practices with both external and internal stakeholders, and aligned through a mutually agreed action plan with leadership.

Internal Stakeholders: Medical Specialties, Operations, Finance, Sr. Management Insurance & Corporate Teams.

External Stakeholders: Insurance Companies, Third-Party Administrators (TPAs), Aggregators & Broking Firms, Corporates & PSU Corporates, Government Health Schemes and Patients.

1. Preferred Partner Networks

- Identify key insurance partners and initiate strategic tie-ups based on geography and specialty demand.

- Build trust through transparent reporting, clinical outcomes, and satisfaction metrics.

- Demonstrate value via single-line billing models, day-care procedures, and value-based care (reducing ALOS).

- Conduct periodic outcome review meetings with payors.

- Establish the group as a centre of trust with excellent clinical outcomes within managed care networks.

- Ensure patient satisfaction scores & Net Promoter Score (NPS) with increase in empanelment & revenue.

2. Technology-Based Collaborations

- Predictive analytics to improve health outcomes.

- Establish Centres of Excellence (CoEs).

- Post-discharge patient engagement.

- Unified platform for clinical, operational, and financial KPIs.

- Reduced Average Length of Stay (ALOS).

- Better tariff negotiations with insurers.

- Integration with payor technologies for pre-auth/discharge.

- EHR/EMR integration with insurer portals.

- Patient engagement platforms.

3. Centralized Claims Management

- Central processing of pre-auth, claims, reconciliation, and recovery.

- Workflow automation across centers.

- Centralized dashboard for TAT, denials, and approvals.

- Real-time alerts & exception management.

- Establish a robust corporate claims system.

- Standardized SOPs and build efficient claims processing team.

- Training programs for clinicians and back-office staff.

- Regular audits and upgrades.

4. Revenue Realization Process (RCM Optimization)

- Patient Access & Registration - insurance eligibility verification.

- Clinical Documentation Improvement (CDI).

- Claims Lifecycle Automation - real-time tracking & rejection prediction.

- Denial Management - root cause analysis and appeals.

- Financial Counselling - upfront estimates and patient guidance.

- Higher first-time approval rate with lower claims denial rate.

- Reduced Days Sales Outstanding (DSO).

5. Grievance Redressal & Troubleshooting

- Build a responsive, empathetic support ecosystem for patients and insurance partners.

- Cross-functional team with finance, clinical liaisons, and insurance coordinators.

- Multi-channel communication (helpline, WhatsApp, email, in-person).

- Escalation matrix with defined TATs.

- Monthly review of complaint trends and resolutions.

- Improved patient experience & trust with strong payor relationships.

- Lower legal/compliance risks.

Qualifications & Experience

- MBA/PGDM in Sales, Marketing, or Healthcare Management.

- 12-18 years of progressive experience in healthcare business development, with at least 5+ years in a leadership role.

- Proven track record in:

- Government scheme tie-ups (State/National Health Programs, PSU collaborations).

- Insurance & TPA empanelment, tariff negotiations, and claims management.

- Corporate client acquisition and lead generation across sectors.

- Demonstrated success in driving revenue growth through payor channels.

- Strong industry network with insurers, TPAs, government bodies, aggregators, and corporate HR decision-makers.

- Excellent negotiation, communication, and stakeholder management skills.