Health Coach

Job description

**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 managemen