Job title: Vertical Head Health Operations

Company: Bajaj Allianz General Insurance Company Limited

Job description: Job Description : * Planning and Review * Spearhead implementation of processes to ensure overall service delivery in line with expectations / set targets Review key performance metrics and service level agreements (SLAs) related to TAT, qualit

Job Description : Planning and Review Spearhead implementation of processes to ensure overall service delivery in line with expectations / set targets Review key performance metrics and service level agreements (SLAs) related to TAT, quality and production parameters for the different processes for both internal teams and vendors Closely monitor the cases flowing in, daily volumes, daily production, TAT, deficiency buckets, etc. Track deviations and provide inputs to the team on course correction Forecasting & Capacity Planning across entire vertical Analyze past manpower utilization, business and volume growth plans Consolidate and prepare the manpower requirements for the current year for the department across processes Review with Head of Operations for inputs and incorporation into functional plans P & L – Cost management Operational management Manage service delivery & key metrics – TAT, Accuracy, Productivity, NPS, Grievance, Audit & Compliance across below processes. Review the escalations related to TAT, quality issues, data entry errors, etc. Study the case for reasons for delay and deficiency Guide and provide inputs to resolve the escalations Oversee process implementation, review policy issuance and endorsement processes to ensure proper governance mechanism and checks are in place before cases are processed across all below processes. Spearhead, Plan , organize and control Pan India health Insurance operations , by managing a large team of 6 managers, 10 TLs, 20 Bagic & 30 Bass resources, 31 IHMS & writer resources for claims, 90+ PPMC outsource agents who manage & process 1.2 Crore transactions annually from various processes like Retail health , GC & PA (Policy Issuance – New business, Renewals, Portability, Endorsements, Grievance, Refunds), Group health (GMC & GPA Policy Issuance – New business & renewals, Endorsements, Ecard portal, Benefit calculation, Cancellation & Refunds), Printing/Dispatch for group health, Claims Scanning & Inwarding , EMI Process & Reconciliation , Pre-insurance health Check-ups, Free Health check-ups, Segmented Serving & Agent support services . Head system enhancements & developments for E2E Retail & Group health & claims Inwarding from Requirement gathering, Preparing BRDs, Test cases, UAT testing across Core systems (Opus /Maximus/GC/PPM) & all other external platforms. Lead & drive external issuance program for the entire company across all LOBs (Health, PA, Motor, Property, Marine & other commercial lines – From product enablement, feature/functionality enablement across digital platforms like Agent portal, broker portal, corporate portal, Agent App, Customer App, Loaders, APIs, website & driving adoption through business channels & Partners / IMDs. Spearhead & Manage the third-party administrators for PPMC / Medical checkup vendors to ensure service delivery & desired performance levels and quality. Spearhead & Manage the outsourcing partners/ vendors for Segmented Serving & Agent support services to ensure service delivery & desired performance levels and quality. Spearhead & Manage the outsourcing partners/ vendors for Claims Inwarding & Scanning services across India (200 branches) Pre Policy Health Check-ups and Tele MER Process: Drive & monitor day to day service delivery & operations associated with Prepolicy Health Check-ups, Free health checkups and Tele-MER & ensure TPAs are meeting all Underwriting guidelines and service parameters. Drive & ensure uninterrupted process of organizing these checkups for customers at the diagnostic centers or through Home visit as per their choice / location Drive & monitor Empanelment of additional vendor(s)/ and De-listing/empanelment of Diagnostic centres on TPA panel Weekly/monthly review with TPAs – various departments and support staff Retail Health Issuance & Endorsements: Drive & monitor service delivery across Pan India & ensure policy are issued within agreed TAT Ensure policies are issued with agreed quality parameters Ensure team is fully capacitized to handle daily volumes Rigor & governance Monitor & manage team pendency & ensure deficiency cases are highlighted to business team for resolution Group Health Issuance & Endorsements: Drive & monitor service delivery across Pan India & ensure policy are issued within agreed TAT Review and guide team to ensure accurate data management with respect to GMC & GPA member enrolments, member IDs, data processing across & enrollment & Health claim module Ensure team is fully capacitized to handle daily volumes Monitor & manage team pendency & ensure deficiency cases are highlighted to business team for resolution Claims scanning & Inwarding: Daily monitoring of no of health claim documents submitted across HO & 200 branches Pan India & ensure all protocols and SOPs are followed in while scanning & Inwarding the documents Ensure team is fully capacitized to handle daily volumes & ensure back up support for document scanning & Inwarding for locations with sudden high volumes Monitor & manage team pendency & ensure deficiency cases are highlighted to business team for resolution Segmented Servicing & Agency Care Cell: Daily monitoring of no of health claim documents submitted across HO & 200 branches Pan India & ensure all protocols and SOPs are followed in while scanning & Inwarding the documents Ensure team is fully capacitized to handle daily volumes & ensure back up support for document scanning & Inwarding for locations with sudden high volumes Customer & stakeholder management Manage operations support for business channels – Health Vertical, Retail Agency, Bancassurance (PSUs,Pvt Banks, NTUs, Cooperatives, NBFCs), Corporate Mktg, VSO, Direct Mktg, Websales, Web aggregators like Policy Bazar, Flipkart, Phone Pe, PayTM, Mobikwik. Project management and implementation for new innovations, systems developments, OPUS / Maximus Drive system developments Scan and research best practices and new trends in process and systems for health operations Meet vendors and partners to identify solutions that can be applied for our company Analyze current systems and their gaps to generate ideas for changes, enhancements and improvements in our internal core system and applications across processes and systems Oversee and expedite enhancements in corporate portal, broker portal integration with vendors and partners, etc. for health category In discussion, define the project, develop project plan and define timelines for completion of projects For company-wide projects (such as digital forms, external issuance), provide guidance to the project team to prepare project plans, supervise execution, address issues and remove roadblocks Periodically monitor progress of projects and timelines of key milestones Coordinate with various cross-functional teams, seek prioritization for own projects with IT teams and review development to ensure projects are delivered on time and as per set expectations Periodically present the status and overview of existing projects to the Head of Operations for review and seek course correction inputs Prepare and share updates with CEO and Shareholders, as needed Vendor management Lead the shortlisting, selection and on-boarding of vendors / Third Party Administrator (TPA) Float RFP to potential vendors, review quotes and proposals, undertake technical and cost evaluation, adhere to budgets set with underwriting and actuarial team Prepare recommendation and submit to finance and legal, for selection and on-boarding Periodically (weekly, monthly, quarterly) have reviews with vendors to check performance against the set SLAs and quality metrics Provide feedback and inputs to enhance quality and TAT to align with BAGIC expectations Review and analyze to provide resolution on critical escalations/ issues to vendors People & Team management: Manage hiring, headcount as per AOP budget Participate in selection process to identify the right talent at senior positions within the function Set Goals & allocate responsibilities to the team, establish individual performance expectations and regularly review individual performance of the team Performance management – KPIs / Leaves Team engagement – Ensure regular 1-O-1 & team discussions are held to keep team fully engaged & motivated Drive & monitor Rewards program & feedback mechanism Mange attrition / backfilling replacements by working closely with HR team Team development / Training / Succession planning Ensure effective training & coaching as per process protocols & learning curve Ensure People development & succession planning Identify development needs of talent and create development plans to build domain expertise and enhance operational knowledge Digital issuance Program across all LOBs (Health, Motor, Property, Marine & other commercial lines) Lead & drive external issuance program for the entire company across all LOBs (Health, PA, Motor, Property, Marine & other commercial lines Drive product enablement & feature/functionality enablement across digital platforms like Agent portal, broker portal, corporate portal, Agent App, Customer App, Loaders, APIs, website. Driving adoption through business channels & Partners / IMDs. Launch & drive campaigns for pushing digital adoption Drive training programs for IMDs / partners on digital issuance platforms / processes Compliance, Risk & Audit Ensure all the processes across health Ops are complaint as per IRDA / regulatory guidelines Identify, flag & mitigate any risk to the processes Ensure audit score of 70 & close any audit observations within timelines Customer Grievance Ensure all IRDA & Non IRDA customer grievances are actioned & responded to CS team within timelines Ensure all IMD escalations are actioned & responded to CS team within timelines Perform periodic analysis of customer grievances and identify root causes basis ACPT approach Resolve system issues identified in ACPT approach to prevent further escalations Streamline processes & deploy enablements identified in ACPT approach to prevent recurrence of customer escalations Customer & Partner NPS Ensure satisfactory NPS / CSAT score across all the processes in Health Operations from internal & external customers & partners / IMDs Desirable Skills : . Minimum 12 years of experience . Minimum 10 years of team handing experience Education/Qualification:. Minimum qualification required: Post-graduation in any field . BPT, Clinical research Management / medical / paramedical education is preferable Years Of Exp :12 to 15 Years

Expected salary:

Location: Pune, Maharashtra

Job date: Thu, 17 Mar 2022 23:28:22 GMT

Apply for the job now!