Senior Manager - Claims (Hyderabad )

Designation: Senior Manager

Location: India Telangana Hyderabad

Organization: Financial Services

Job Description:

Job Purpose

To role is required to manage Claims Payments of Indemnity & Fixed Benefit Claims; within specified TAT & as per IDRA Guidelines

Job Context & Major Challenges

Job Context / Job Challenges:

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.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 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.

Key Challenges for the role –

Create, monitor and improve Innovative Claim Processes, SOPs, Protocols & implement the same for Claims Processed through In-house Team as well as Claims Processed through Partner TPAs

Ensuring that the team members are up-to speed in a short time frame and enhancing their Skills by Periodic Functional & Product Training Programs

System development & UAT, Claims: Indemnity & Fixed Benefit Products (Retail & Group)

Expectations management of the Claims team & TAT & expectations management for specialized business handling.

Periodic Portfolio analysis & Maintain a consistent service delivery to ensure client retention and satisfaction

Minimise Loss Ratio & Monitor the Profitability of Portfolio

Key Result Areas

KRA (Accountabilities) (Max 1325 Characters)

Supporting Actions (Max 1325 Characters)

KRA1

IT Systems Development

1. System development, UAT Indemnity & Fixed benefit products (Claims)

KRA2

Monitor Claims Team Performance metrics

1. Monitor Claims transactions, authority limits, TATs

2. Appropriate & timely resolution of escalations

3. Measure Claims decisions: Quality & TAT (in House & TPA processed Claims)

4. Review of o/s Claims

KRA3

Recommend empowerment for Claims Officers

1. Audit

2. Training

KRA4

Review the Claims guidelines v/s competition

1. Analyze business trends, recommend changes if any.

2. Perform cost benefit analysis.

KRA5

Claims Analysis, Processes improvement, TAT

1. Identify the process lapses

2. Coordinate with IT/Support functions for rectification

3. Stay abreast with newer Claims processes/suggest improvements

KRA6

Facilitate training: Self, Claims officers & non-medical resources

1. Acquire required technical qualification and training.

2. Training of New Team Members & provide guidance to them about the Internal as well as external processes

KRA7

Manage the assigned specialized business handling of any one or more of the supporting actions in order to provide quality support for New Business/Retention

1. Claims System Development, UAT, Indemnity and Fixed benefit products

2. Address complaints/queries from Customers, Intermediaries, Sales, other departments within the Company

3. TPA Audits & Training of New Team Members