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Aditya Birla Capital Limited (“ABCL”) is a listed systemically important non-deposit taking Non-Banking Financial Company (NBFC) and the holding company of the financial services businesses. ABCL and its subsidiaries/JVs provides a comprehensive suite of financial solutions across Loans, Investments, Insurance, and Payments to serve the diverse needs of customers across their lifecycles. Powered by over 63,750 employees, the businesses of ABCL have a nationwide reach with over 1,712 branches and more than 200,000 agents/channel partners along with several bank partners.
Nationwide Branches
1,712
No. of Employees
63,750+
Agents/Channel Partners
2,00,000+
Aggregate Assets
INR 5.50 Lakh Cr
Active Customer Base
39 Million
Consolidated Lending Book
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Aditya Birla Capital Limited
Aditya Birla Capital Limited (“ABCL”) is a listed systemically important non-deposit taking Non-Banking Financial Company (NBFC) and the holding company of the financial services businesses. ABCL and its subsidiaries/JVs provides a comprehensive suite of financial solutions across Loans, Investments, Insurance, and Payments to serve the diverse needs of customers across their lifecycles. Powered by over 63,750 employees, the businesses of ABCL have a nationwide reach with over 1,712 branches and more than 200,000 agents/channel partners along with several bank partners.
Nationwide Branches
1,712
No. of Employees
63,750+
Agents/Channel Partners
2,00,000+
Aggregate Assets
INR 5.50 Lakh Cr
Active Customer Base
39 Million
Consolidated Lending Book
INR 1.78 Lakh CrCorporate Governance Policies
Financial and Debt-Related Policies
Business and Partnership Policies
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Life Insurance
Health Insurance
Home Finance
Personal Finance
| 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 |
| 1) 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. |
2) 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 | On Roll – 6000 Offroll/ Partime - 4000 | ||||||||||||||||
Unit Workforce Number | On Roll – 6000 Offroll/ Part time - 4000 | ||||||||||||||||
Function Workforce Number | On Roll – 800 Offroll/ Part time - 200 | ||||||||||||||||
Department Workforce Number | 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 |
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| 3) 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 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.
Market Opportunities – With the advent of medical advancements, lifestyle changes, change in Indian socio-economic scenario and Indian healthcare space, and the insurers are facing challenges to cater to the needs of this diverse clientele. Increasingly Indian customers have started considering health insurance partners as extensions of health advisers. In this scenario it becomes extremely important to understand their psyche and then provide tailored solutions with wellness benefits which would help them meet their end objectives and bring in profitable revenue source for the company.
About the Aditya Birla Health Insurance –
Aditya Birla Health Insurance Co. Limited (ABHICL), a part of Aditya Birla Capital Ltd. (ABCL), is a joint venture between Aditya Birla Group and MMI Holdings of South Africa. ABHICL was incorporated in 2015 wherein Aditya Birla Capital Limited (ABCL) and Momentum Metropolitan Strategic Investments (Pty) Limited (Formerly known as MMI Strategic Investments (Pty) Ltd.) were holding 51% and 49% equity shares respectively. ABHICL commenced its operations in October 2016 and is engaged in the business of health insurance. Company’s current product portfolio includes unique offerings including chronic care and incentivized wellness. ABHICL became an associate company of Aditya Birla Capital Limited (ABCL) on October 21, 2022 post the allotment of 9.99% of equity shares of the Company to Platinum Jasmine A 2018 Trust, acting through its trustee Platinum Owl C 2018 RSC Limited (‘Investor’), an affiliate of Abu Dhabi Investment Authority (‘ADIA’). Consequently, Aditya Birla Capital Limited (ABCL) and Momentum Metropolitan Strategic Investments (Pty) Limited (Formerly known as MMI Strategic Investments (Pty) Ltd.) holds 45.91% and 44.10% of shares respectively.
As on H1 FY22 end, ABHICL recorded a gross written premium (GWP) of Rs.764 Crore and covered more than 16.2 Mn lives. ABHICL has nation-wide distribution presence in over 2800+ cities through branches and partner offices, 11 bancassurance partners and over 51,120+ direct selling agents. ABHICL has scaled and diversified digitally enabled distribution through 40%+ agency growth with 175 branch locations, bancassurance available through 16,000+ branches, and 39+ digital partners covering 6 Mn.+ lives through 50+ contextual byte-sized products.
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
|
| 4) Key Result Areas: Write the key results expected from the job and the supporting actions for each of these key result areas (For a majority of jobs typically there could be 4- 7 key result areas) | |
Key Result Areas | Supporting Actions |
Help create a quality pool of providers across the country within reasonable reach of the customers within minimum reasonable time frame to meet the business requirement – New empanelment |
|
Drive the commercial negotiations with the providers to ensure the best deal for the end consumer and keep the ACS under planned number. |
|
Enhancing the cashless utilization for better customer experience. |
|
Ensure that team has well defined roles, training plans, and developmental initiatives from time to time. |
|
Ensuring compliance and regulatory requirements are met all the time related to provider network area |
|
| 5) Job Purpose of Direct Reports: Describe the job purpose of the direct report/s to the job (in 2-3 lines for each report) |
|
| 6) Relationships: Describe the nature and purpose of most important contacts or relationship (except superior/team members) with individuals, departments, organizations inside and outside of the organization, that job is required to interact with in order to deliver the job objectives | ||
| Relationship Type | Frequency | Nature |
Internal |
|
|
Corporate Underwriting Team
Claims Team
Customer Service Team
Pricing and Product Team
Sales Team
DRM Team
Legal & Compliance
Digital and IT |
High
High
High
Medium
High
Medium
Medium |
Supporting the TPA fees negotiation
Ensuring cost efficiency through effective provider negotiations
Resolving customer complaints and grievance through working with providers
Helping in building right pricing assumption and validating the product ideas
Providing on ground support through building high quality network, arranging events for group clients
Ensuring network availability and cost negotiation
Contract Designing and ensuring compliance to regulations
Ensuring system readiness and ensuring digital experience for providers and customers |
External |
|
|
Healthcare Providers
TPAs
Tech Partner
Group HR
Wellness Partners
Affinity Partners
Industry Forums and Association |
High
High
High
High
High
High
Medium |
Contract T&C, Tariff negotiation, Ensuring customer experience at point of service – Hospitals, DC, Pharmacy, Clinics
Managing GHI policies and Empanelment
Integration and data exchange
Wellness Offerings, AHC & D/HA
Corporate offerings
Empanelment’s & VAS for Retail & corporate customers
Driving ABHIs agenda, discussion with hospitals, Nursing Home and Consultants associations |
| 7) Organizational Relationships: Provide the structure for a level above and below the position for which this job description is written. Use position titles in the structured and indicate all the reports of the position. |
| SIGN-OFF: Provide the name of the Manager and the jobholder. Signature needed for the hard copy of the JD. Hard copy to be maintained in the organizational record. | ||
| Job Holder | Reports to – Manager |
Name |
|
|
Signature (needed for the hard copy) |
|
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4 - 8 years
02 degree