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Job Description & How to Apply Below
Basic Details:
Fill the required information about business, unit, location, position, reports to position and date of updation of JD
Business
Financial Services
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
Head – Provider Network
Reports to:
Poornata Position Title
Chief Operating Officer
Function
Operations
Reports to:
Function
Operations
Department
Ops – Provider Network
Reports to:
Department
Operations
Designation of the Employee
Vice President
Designation of the Manager
Executive Vice President
Date of writing/updation of JD
Jan 2024
Job Purpose:
Write the purpose for which the job exists (in 2-3 lines)
The role is responsible to lead the designing and execution of strategy for Provider Network of ABHI and will be responsible for managing partner relationship, expansion of hospital network to all possible location having policy distribution, controlling the ACS (Average claim size), Negotiating the tariffs with hospitals and creating preferred provider network having package-based pricing for possible services. Managing OPD / wellness partners and TPAs through health claims, PPMC, D/HA and Health checks and its related commercials, evaluating new health tech partners and ensuring the deliverables for customer servicing.
The role will also be responsible for creating and managing DC network (Diagnostic centers) PAN India through the aggregator or direct partners.
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)
On Roll – 6000
Offroll/ Partime - 4000
Unit Workforce Number
(Max 254 Characters)
On Roll – 6000
Offroll/ Part time - 4000
Function Workforce Number
(Max 254 Characters)
On Roll – 800
Offroll/ Part time - 200
Department Workforce Number
(Max 254 Characters)
On Roll – 23
Offroll/ Part time – 4
Other Quantitative and Important Parameters for the job:
Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter
Manage & Direct Processing of transactions
India Head – Provider Network (August 22 to till date).
Coverage of No. of Hospitals in Network /Cities
FY 22-23- 10693 / 983,
FY 23-24- 11180 / 1095,
Span of the role
No. of Other Providers (Diagnostic Centre, Consultant, Pharmacies) in Network /Cities
FY 22-23- 6800 / 2036
FY 23-24- 7708 / 2308
No. of TPAs/ Institutional Partners
FY 22-23 – 12 / 06
FY 23-24 – 12 / 09
No. of Annual Health Checks/PPMC
FY 22-23 – 37182 / 3941
FY 23-24 – 24289/ 6573
Processing Parameters
Managing Claim and Other Payout / volume to PN relationships
FY 21-22 – 405 Cr / 57,380.
FY:22-23 – 364 Cr / 48,498.
Vendor Management
OPD Insurance product and partner management
Group wellness and OPD business through aggregator partners offering digital / tech platform-based journey for customers. Having pre-defined network of doctors, pharmacy, diagnostics centers, dental, vision, vaccination, mental health, fitness centers - Gyms, yoga centers, & nutrition services.
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 25,000 Crs sees close to 80-85 % 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. 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…
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