Chief Manager - HRM Analytics & Policy

ROLE DESCRIPTION:

To drive the policy making agenda for the organisation from the Health Risk Management (HRM) perspective. The role would be responsible for Creating/revising policies for all HRM interfacing functions - underwriting, claims, Clinical Quality & Governance (CQG), fraud control, processes for ombudsman & consumer forum etc.

Ensure HRM alignment of all products - product design, policy terms and conditions, inclusions, exclusions and definitions

Drive HRM analytics from the clinical perspective

JOB RESPONSIBILITIES:

Creation and Review of Policies for key process:

- Underwriting

- Claims

Decision making on specific exception requests to policies

Product specific manuals aligned to policies (underwriting and claims)

Creation of clinical rules and ICD/CPT code masters to assist analysis and automation of processes

Cross functional projects such as new product launch/product revision especially in context of HRM alignment of policy terms and conditions, product benefits, exclusions, definitions, underwriting and claim manuals

Learning and integration through process of health risk selection, assessment and management

Close monitoring and tracking of deployment, adoption and implementation of policies across functions

Meticulous documentation of all Policies

Creation and Updation of key HRM related policies

Complete documentation of the policies with version control and due sign offs

Efficacy of clinical inputs into analytics & implementation

Adherence to timeline and quality of deliverables as per defined criteria

Requirements:

MBBS - qualification is mandatory for a strong candidate

Professional insurance and/or health certification/training/diploma/degree will be an added advantage

Demonstrated experience of 7-9 years in the health industry

Recent direct experience and exposure to health risk management functions, especially underwriting and claims in an health insurance company (experience in retail insurance products is desirable)