AM/DM- Health Management

Basic Details: Fill the required information about business, unit, location, position, reports to position and date of updation of JD

Business Health Insurance

Unit Aditya Birla Health Insurance Company Ltd

Location MBC, Thane

Poornata Position Number of the job Reports to: Poornata Position Number

Poornata Position Title of the job (30 characters max) Reports to: Poornata Position Title

Function Operations

Reports to: Function Operations

Department DMR- Lifestyle coach

Reports to: Department DMR- Health Management

Designation of the Employee Assistant Manager

Designation of the Manager Deputy chief manager

Date of writing/updation of JD May 23rd, 2022

• Job Purpose: Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters) The role is responsible for planning, and coordinating operational activities for the organization. Providing support to the team and helping business in achieving success from the same.
• Dimensions: Mention quantitative or qualitative parameters that are relevant for the job and provide a better understanding of the scope and scale of the job. Business Workforce Number (Max 254 Characters) Unit Workforce Number (Max 254 Characters) Function Workforce Number (Max 254 Characters) Department Workforce Number (Max 254 Characters)

20 Other Quantitative and Important Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter Good knowledge on MS office and Excel.

• Job Context & Major Challenges: Write the specific aspects of the job that provide a challenge (internal and external) to the jobholder in the context of the Business/Unit/Function/Department/Section ((Max 3975 Characters)

About The Aditya Birla Health Insurance – Aditya Birla Health Insurance Co. Limited (ABHICL) was incorporated in 2015 as a 51:49 joint venture between Aditya Birla Capital Limited (ABCL) and MMI Strategic Investments (Pty) Ltd. ABHICL commenced its operations in October 2016. ABHICL has entered the competitive health insurance market with an aim to expand the category to wider customer segments, beyond the ones that health insurance companies traditionally have marketed to. As the 6 th entrant in a category with well-established players, ABHICL is creating differentiation and equity for itself though the unique business proposition of “Health Insurance for All”, a one of a kind proposition in India at the moment. This is a philosophy that is being built through every single consumer touch point and into every single backend process of the company to ensure a customer’s experience of our proposition is continuous and seamless. ABHI’s unique offering to market includes proposition includes -

• A Comprehensive Incentivized Wellness Program that will attract the young and health conscious and will motivate, guide and reward them to stay healthy
• A Chronic Care Management Program to cater to the unmet needs of a growing Indian population of those suffering from chronic lifestyle conditions like Diabetes, Asthma, High Cholesterol and Hypertension from Day 1
• ABHICL serves as an enabler and influencer of health and healthcare choices that customers make, in addition to being a payer of healthcare expenses. Thus, ABHICL would act like a much needed catalyst to grow the prevalent health insurance landscape in India through product innovations and a wider choice of consumer relevant products.
• ABHICL’s vision has always been digital. The company has been successful in adopting paper-less approach right from identifying to on-boarding to delivering seamless experience of its customers & employees.
• Co-operation from stakeholders in timely execution of Risk Actionable & Internal audit (including sharing of data requirement to management response for closure of audit report)

Key Challenges for the role –

• Knowledge of DRM processes:
• Stay abreast with new processes / suggest improvements
• Understanding of DRM systems (process flow & System fields)
• TAT & expectations management for specialized business handling.
• Co-ordinate with other departments, team members and management to ensure smooth information flow to ensure that operations are carried out, recurring issues are resolved.
• Create & maintain standards/protocols for DRM team
• Maintain a consistent service delivery to ensure client retention and satisfaction
• Identify risks to the company and escalate accordingly
• Execution of processes–operations, to be in line with defined standards
• Inputs for refinement and development of guidelines and procedures.
• Publishing raised claims with Claims Team and sharing a positive feedback
• Ensure timely and accurate updation of various documents/reports in compliance with the SOP
• Key Result Areas: Write the key results expected from the job and the supporting actions for each of these key result areas (For a majority of jobs typically there could be 4- 7 key result areas)

Key Result Areas Supporting Actions management of customers with diseases & delivering as per internal medical protocols

• Manage high disease risk customers/patients over the phone/emails/EMR and, if required, in person
• Should understand the medical diseases and finer details of their management protocol along with the finer details of the program construct
• Follow/Develop a detailed plan of tracking as per the protocol keeping in mind the complications that could arise
• Coordinate with external customer’s/patients basis the risk trigger ensuring maximum level of sensitivity and confidentiality while managing cases
• Managing all cases on a case to case basis ensuring that majority customers/patients are adhering to the program construct
• Manage changes and escalations effectively on a case to case basis
• Measure program performance with relevant reports and at define frequency
• Report and escalate to management as and when needed
• Successfully manage the relationship with all stakeholders, internal as well as external
• Perform risk management to minimize risks at a customer level as well as at a portfolio level
• Establish and maintain relationships with third parties/vendors Process Improvement
• Review the processes on a timely basis
• Work towards digitization at each stage
• Identify opportunity for improvement basis partner’s feedback Reports and MIS
• Conceptualization of new MIS design and delivery
• Publish Dashboards with analysis and insights Governance
• Leakage management and Governance around payment, customer benefit utilization
• Manage Internal & external process Audits
• Adherence to all Regulatory requirements and quick adaption to regulations
• Job Purpose of Direct Reports: Describe the job purpose of the direct report/s to the job (in 2-3 lines for each report) NA
• Relationships: Describe the nature and purpose of most important contacts or relationship (except superior/team members) with individuals, departments, organizations inside and outside of the organization, that job is required to interact with in order to deliver the job objectives

Relationship Type (Max 80 Characters) Frequency

Nature (Max 1325 Characters) Internal New Business & Policy Administration Legal/Compliance Sales IT Underwriting Internal Audit Team Provider Management Team Product Team / Actuary Team Contact Centre Team (CRM team) Need Based Need Based Need Based Need Based Need Based Need Based Need Based Need Based Need Based Escalation Resolution w.r.t. File movement / daily update Legal & compliance issue w.r.t to policies in Claims Query Resolution System enhancements/issues. Updating w.r.t guidelines or resolving queries Internal / External Audit General enquiry New product development/launch related. Resolutions of Queries and Management of Escalations.

External Policyholders Vendors Need based Daily/need based Sending emails/ query resolution Allocation of daily work.

• Organizational Relationships: Provide the structure for a level above and below the position for which this job description is written. Use position titles in the structured and indicate all the reports of the position.

SIGN-OFF: Provide the name of the Manager and the jobholder. Signature needed for the hard copy of the JD. Hard copy to be maintained in the organizational record. Job Holder

Reports to – Manager Name Signature (needed for the hard copy)