TM-Case Management (Thane)

Aditya Birla Health Insurance Company Limited; Maharashtra; On-site; INR 1,800,000 - 3,600,000; Full time

Job summary

Aditya Birla Health Insurance Company Limited seeks a Zonal Manager – Provider Network to lead the growth and management of a comprehensive healthcare provider network across zones. You will negotiate tariffs, establish MoUs and drive quality service delivery with partners and providers.

Aligned with ABHI's Health Insurance for All mission, you will coordinate across sales, operations and IT to ensure seamless cashless experiences and scalable provider relationships across East, South, North and

Qualifications

• The role will be responsible for creating, developing & managing a comprehensive network of healthcare providers and partners across the Zone.

Responsibilities

• Directly responsible for creating and managing relationships with 3000-4500 providers across Zones.
• Negotiate tariffs and MoUs with providers to enable affordable healthcare delivery for OPD & IPD.
• Drive selection, empanelment & network expansion to ensure seamless customer experience.

Job description

Annexure I : ABG Job

Description Template

HayGroup Job Description Template 2011 Error! Unknown document property name. 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 East, South, North and West Zone Poornata Position Number of the job

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

Reports to: Poornata Position Title Function Operations Reports to: Function

Operations Department Ops - Provider Network and Strategy Reports to: Department

Operations Designation of the Employee

OPN10 - Zonal Manager PN Designation of the Manager

OPN1- Head Provider Network & Group Ops Date of writing / updation of JD 28 October 2017

Description Template

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

The role will be responsible for creating, developing & managing a comprehensive network of healthcare providers and partners across the Zone along with team members across assigned geography. The role will also be responsible to negotiate best tariff structure for ABHI and manage the renewals and relationships while being responsible for making sure delivery of quality services as per signed SLAs.

• 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.

Direct Reports

1- 3 Number of Provider

• Directly responsible along with team members to create and manage relationship with 3000-4500 providers across Zones. ? Network of non-hospital Healthcare Providers ? Network to manage Group, Retail and Rural business

Planning for Empanelment ? Directly responsible to create OPD & IPD network in respective zone in providing seamless experience to customers Tariff & MoU Negotiation ? Responsible for negotiating best tariff & validity, and contracting with best discount with the providers to facilitate affordable healthcare delivery for both OPD & IPD 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

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 nationalized 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.

Market Opportunities –

With the advent of medical advancements, lifestyle changes, change in Indian socio economic scenario and Indian healthcare space, and the insurers are facing challenges to cater to the needs of this diverse clientele. Increasingly Indian customers have started considering health insurance partners as extensions of health advisers. In this scenario it becomes extremely important to understand their psyche and then provide tailored solutions with wellness benefits which would help them meet their end objectives and bring in profitable revenue source for the company.

About The Aditya Birla Health Insurance –

Description Template

HayGroup Job Description Template 2011 Error! Unknown document property name. 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

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 20

• 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 6th 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. Aditya Birla Health Insurance Co. Ltd. which started operation in 2016 having its corporate office in Mumbai and having potential to develop a vast customer base in the region. Hence developing a network of Healthcare Providers both hospital & non-hospital based providers & maintaining relationship with provider in line with its objective to provide seamless healthcare experience to its clients is one of the primary responsibility. In today’s scenario, it is apt to create a network of healthcare providers that reaches the furthest corner of the respective zone to provide the true cashless experience and a sense of holistic healthcare to the policy holders. In context, it is also of paramount importance to assure the level of quality delivered through the providers and also to ensure the cost effectiveness of the services.

As key Provider Network and Relationship, the person has an overall responsibility of implementing an enterprise-wide agenda of building a market leading Provider Network. The person needs to develop business strategy to have Healthcare Contracting and making sure service quality at point of delivery which is best-in-class. The challenges in job:

• Ensuring the quality service delivery, given the spread of providers across the zone is a challenge.
• Huge difference in parity of pricing remains another challenge
• No control mechanism on increasing cost of healthcare due to inflation and technological advancement or on improving lifestyle of customer.
• The entire healthcare sector is non regularized; therefore, creates more challenging environment
• IT advancement level is very low in healthcare industry, driving the digital experience through integration with providers is going to be challenge.

Description Template

HayGroup Job Description Template 2011 Error! Unknown document property name. 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

• 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 ? Help create a quality pool of providers across the zone within reasonable reach of the customers within minimum reasonable time frame to meet the business requirement. ? Responsible to create comprehensive hospital and allied healthcare network through direct tie ups

• Creating hospital network spread across Districts, Cities and rural locations across India ? Responsible to create network of healthcare providers in accordance to sales strategic expansion and new target locations.
• Drive the commercial negotiations with the providers to ensure the best deal for the end consumer. ? Responsible to analyze claims portfolios of the respective zone and accordingly devise discussion agenda with hospitals ? Managing to minimize Organisational claims spent on payout by means various negotiation parameters like, Volume discount, Early payment discount, Service level discounts and corporate based discounts. ? Doing market research and competitors bench mark pricing, approach provider for agreeing on ABHI packages. ? Target for Better and improvised negotiation with top utilised providers based on disease category ? Allow ABG customers to access quality healthcare at optimum pricing ? Responsible to devise discussion agenda with the providers to get Early Payment Discount ? Negotiating MoU conditions with the provider ? Out Patient Strategy & Implementation ? Responsibility to create OPD & DRM network of Consultants, Diagnostics chains & Pharmacy stores in respective regions

Description Template

HayGroup Job Description Template 2011 Error! Unknown document property name. ? Driving Automation in hospital empanelment process ? Assuring Digital Adoption for claim data exchange by providers

• Corporate Wellness Initiatives & Leads sourcing camps ? Responsible to arrange Health Talks, Wellness Camps for the Corporates as part of wellness calendar ? Responsible to organize Health talk and Wellness camp for business partners and distributor for lead generation and promoting healthier life
• Digital Experience ? Responsible for Digital Adoption by Healthcare Provider thereby improving client’s cashless experience ? Responsible for creating digital experience right from empanelment process.
• Responsible to convert provider claim processing from offline to digital platform by system integrations, and seamless flow of electronic data between ABHI systems and Provider System ? Provider Training and Orientation ? Responsible to train the Healthcare Provider on the process orientation of ABHI and TPA Cashless processing ? Responsible for appraise on Process changes to improve the TATs, provider and customer experience ? Provider Relationship and Management ? Regular meeting with provider to understand the challenges and expectations on service levels ? Responsible for reconciliation of outstanding claims settlement on regular basis ? Review and monitor the service laps and ensure high level service, efficiency and consistency with providers ? Support Distributor Relationships ? Responsible to arrange Health Talks, Wellness Camps for the Corporates & Distribution Partners ? Conducting training to providers on the process followed by ABHI and TPA for Cashless claims ? Initial cashless claim handholding to create a quality and seamless customer experience.

Description Template

HayGroup Job Description Template 2011 Error! Unknown document property name. ? Group Operational Support ? Presenting Corporate review meetings on Policy and claims performance along with sales team ? Cashless and Reimbursement claim coordination support for all sales distribution channels ? Responsible to support and coordinate with

Zonal sales and Group operations for smooth functioning.

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

Sr Exec – Provider Network

The role will be responsible for supporting the assigned regional manager in creating, developing & managing a comprehensive network of healthcare providers and partners as per defined SOPs 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

Frequency

Nature

Internal

Description Template

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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 Claims Team Customer Service Team Pricing and Product Team

Sales Team Digital and IT

High Low Low Medium Low Ensuring cost efficiency through effective provider negotiations

Resolving customer complaints and grievance through working with providers Helping in building right pricing assumption and validating the product ideas Providing on ground support through building high quality network, arranging events for group clients Ensuring system readiness and ensuring digital experience for providers and customers External

Healthcare Providers TPAs

High Medium MoU T&C, Tariff negotiation, Ensuring customer experience at point of service – Hospitals, DC, Pharmacy, Clinics Managing GHI policies and Empanelment

Description Template

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)

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