AMDM- Health Management

Mumbai - India

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

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

1) Job Purpose:Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters)

The role is responsible forplanning and coordinating operational activities for the organization. Providing support to the team and helping business in achieving success from the same.

2) 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.

3) 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 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 customers experience of our proposition is continuous and seamless.

ABHIs unique offering to market includes propositionincludes -

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.
ABHICLs 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 processesoperations 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 ofvarious documents/reports in compliance with the SOP

4) Key Result Areas:Writethe 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 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 partners 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

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

6) 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.

7) 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)

Required Experience:

Manager

Basic Details:Fill the required information about business unit location position reports to position and date of updation of JDBusinessHealth InsuranceUnitAditya Birla Health Insurance Company LtdLocationMBC ThanePoornata Position Number of the jobReports to: Poornata Position NumberPoornata Positi...

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

1) Job Purpose:Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters)

The role is responsible forplanning and coordinating operational activities for the organization. Providing support to the team and helping business in achieving success from the same.

2) 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.

3) 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

ABHIs unique offering to market includes propositionincludes -

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.
ABHICLs 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 processesoperations 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 ofvarious documents/reports in compliance with the SOP

4) Key Result Areas:Writethe 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 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 partners 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

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

6) 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.

7) 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)

Required Experience:

Manager

Key Skills

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About Company

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AMDM- Health Management

Mumbai - India

Job Summary

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

1) Job Purpose:Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters)

3) 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)

4) Key Result Areas:Writethe 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)

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

6) 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)

7) 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.

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

1) Job Purpose:Write the purpose for which the job exists (in 2-3 lines) (Max 1325 Characters)

3) 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)

4) Key Result Areas:Writethe 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)

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

6) 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)

7) 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.

Key Skills

About Company

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