Note:This role is for 6 months as a consultant.

Demonstrated 4-6 years experience in the health industry as a practicing and licensed medical practitioner.

- Extensive medical, insurance industry or medical risk assessment knowledge and experience.

- Professional general or health care management or hospital administration diploma / degree will be an added advantage

Key Responsibilities (Mention a detailed description of key areas of focus, essential functions and primary responsibilities required to be performed by the incumbent to achieve business objectives)

- Case Management - Case Management of admitted patient in co-ordination with treating doctor and hospital for utilization management and thus cost control.

- Provider Quality Assessment & Relationship Management - Assessment of empanelled providers- infrastructure and or services available as per defined criteria. Periodic evaluation of the same. Clinico-operational training, issue resolutions and relationship maintenance with such providers.

- Clinical Governance - Hospital and Diagnostic Center Audit for clinical operation/service to customer base as per pre-set criteria. Other evaluation of medical services provided by contracted entities. Periodic Internal Learning and Development of Medical staff.

- Customer Engagement - Health camps. Wellness and Health Management initiatives for customer base.

- Cross-Functional - Interactions. Medical Product Training. Legal/Marketing/Sales/Training/Claims/ Internal welfare committee agenda/ Etc. (Interactions and joint activities as and when required).

- Preauth and Claim Facilitation (Platinum Members) - Support to platinum customers for their queries related to medical insurance and hospitalization claim process assistance.

Key Measures of Performance (Describe the major performance assessing criteria and expectations from the role)

- Successful case management of the admitted members

- Provider quality & customer engagement activities concluded

- Clinical governance agenda delivered

- Adherence to timeline and quality of deliverables as per defined criteria

Key Relationships (Internal / External) (Mention the set of key internal and external stakeholders)

- Internal: Health Risk Management, HealthCare Purchasing, Claims, Preauthorization, Underwriting, Sales and Marketing, Legal & Compliance.

- External : Customers, Contracted and non contracted hospitals & diagnostic centres, Third Party Administrators, Health professionals and medical practitioners and clinicians, Local ombudsman / consumer forums.

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