Health Coach

Business

Health Insurance

Unit

Aditya Birla Health Insurance Company Ltd

Location

Thane Gcorp, Mumbai

Poornata Position Number of the job

Reports to: Poornata Position Number

120495

Poornata Position Title of the job

Reports to: Poornata Position Title

TM DRM OPS DCMGR

Function

Operations – DRM

Reports to: Function

Operations – DRM

Department

Operations – DRM

Reports to: Department

Operations – DRM

Designation of the Employee s

AM/DM/Mgr

Designation of the Manager

Team Lead - DRM

Date of writing/updation of JD

• Job Purpose: Write the purpose for which the job exists (in 2-3 lines)
  
  

The incumbent will take on the management of diseases with the goal of delivering best health outcome as defined by medical protocol

• 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

Unit Workforce Number

Function Workforce Number

Department Workforce Number

5

Other Quantitative and Important Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter

Claim Adherence at 70%

Reduction in claims frequency by 5%

Improvement in Health Parameters: 70%

Health Parameter under critical level: 95%

• 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
  
  

About The Health Insurance Industry –

While the current market sees more than 15 non-life players in the private space and 5 exclusive private players in the health insurance space trying to capture a sizable market share, the nationalised service provider (6) remains a strong competitor. In addition to this the business dynamics are such that the overall market on an annual basis which is to the tune of roughly 10,000 Crs sees close to 85 % of the business renewing with the existing service provider itself. This narrows down the opportunity of the fresh business actually being seriously fought in the market to approximately 1500 odd Crs. With the SME and the start-ups being the driving force of Indian economy, the opportunity to cater to these segments is immense and is increasing manifold year on year. The challenge here therefore remains as to how we capture a larger share of the opportunity by developing specific solutions to cater each segment of the business. Also by creating an inexpensive and standardized solution to increase the reach into the pockets of channel partners across the country to harness on their captive business and explore new opportunities with them.

Opportunities – With the advent of medical advancements, lifestyle changes, change in Indian socio-economic scenario and Indian healthcare space the clients are facing challenges to cater to the needs of diverse workforce. Increasingly Indian clients have started considering group benefits as a lever to manage employee expectations, talent acquisition and retention. In this scenario it becomes extremely important to understand their psyche and then provide tailored solutions which would help them meet their end objectives and bring in profitable revenue source for the company.

Challenges –

Distribution: How we create specific distribution models to penetrate different market segments remains a challenge. Motivation to channel partners to place business with the co. Activate and manage agent based distribution channel across the country

Long term and short term strategic plans to increase the market share and profitability in line with the company's business objectives.

Identifying new segments, structure offerings, and value enhancers apart from creating differentiators remains a big challenge for the company's growth. Meeting varied client's expectation in terms of solutions, pricing and operational support remains a challenge.

Build and further enhance relationships with key customers and partners alike.

Build the vertical in line with the leadership teams expectation of having the group benefits team contributing substantially to the bottom-line in years to come

• Principal Accountabilities
  
  

Accountability

Supporting Actions

Effective 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 customers/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
• Job Purpose of Direct Reports: Describe the job purpose of the direct report/s to the job (in 2-3 lines for each report)
• 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 Frequency Nature

Internal

COO

Monthly & Need based

Brief to detailed. To get tactical inputs in order to drive efficiency and effectiveness

Customer Service and Partner Management

Need Based

To understand the needs and provide optimal business solutions

Department SPOCs – IT, Planning, Finance, Training etc

Need Based

Close any gaps hampering business processing

External

• Partners
  
  

Monthly and Need based

To discuss the challenges faced in servicing customers

• 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)