Vertical Head Health Operations Job Vacancy in Bajaj Allianz General Insurance Company Pune, Maharashtra – Latest Jobs in Pune, Maharashtra

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Company Name : Bajaj Allianz General Insurance Company
Location : Pune, Maharashtra
Position : Vertical Head Health Operations

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, 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
Department
:
HO
Open Positions
:
1
Skills Required
:
Strong experience of health insurance operations
Location
:
HO – Direct Marketing / Pune
Education/Qualification
:
Minimum qualification required: Post-graduation in any field BPT, Clinical research Management / medical / paramedical education is preferable
Desirable Skills
:
Minimum 12 years of experience Minimum 10 years of team handing experience
Years Of Exp
:
12 to 15 Years
Posted On
:
11-Mar-2022
Designation
:
Vertical Head Health Operations

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