Health Coach

Overview

This role involves managing disease conditions with the aim of achieving optimal health outcomes aligned with established medical protocols. The Health Coach works within the Operations – DRM department at Aditya Birla Health Insurance Company Ltd, based in Thane Gcorp, Mumbai, Maharashtra.

Job Purpose

The incumbent is responsible for managing patients with various medical conditions, ensuring adherence to management protocols to improve health metrics and reduce claim frequency.

Scope and Challenges

The position oversees approximately 5 workforce members within the unit and deals with metrics such as achieving 70% claim adherence, a 5% reduction in claim frequency, 70% improvement in health parameters, and maintaining 95% of critical health parameters within safe levels.

The health insurance industry is highly competitive with multiple national and private players. The company seeks to expand market share by creating tailored, cost-effective solutions for varied segments, particularly SME and startup sectors, and enhancing channel partner reach nationwide.

Key challenges include developing distribution models targeting diverse segments, motivating channel partners, defining strategic business growth plans, identifying new market segments, structuring competitive offerings, and delivering excellent operational and client support.

Key Responsibilities

• Engage with high-risk patients through phone, email, EMR, and in person as needed to provide disease management.
• Possess thorough knowledge of medical conditions and related management protocols.
• Create and follow detailed monitoring plans focused on complication prevention.
• Maintain sensitive and confidential communication while managing patient risk triggers.
• Ensure patients comply with program guidelines and manage escalations as required.
• Measure and report program outcomes regularly, escalating significant issues to management.
• Manage relationships with stakeholders, including external vendors and partners.
• Identify and implement process improvements, emphasizing digitization and partner feedback.
• Develop and deliver advanced MIS reports and dashboards featuring analytical insights.
• Oversee governance aspects such as leakage management, payment audits, customer benefit utilization, and process audits.

Relationships and Interactions

• Monthly and as needed interaction with COO for tactical input to enhance operational efficiency.
• Partner regularly with Customer Service and Partner Management teams to address business needs.
• Coordinate with internal department leads in IT, Planning, Finance, and Training to resolve operational gaps.
• Engage monthly and on-demand with external partners to address service challenges.

Additional Information

The role reports directly to the Team Lead - DRM and involves direct reports such as AM/DM/Manager level employees. Hardcopy job descriptions require manager and employee signatures for organizational records.