Annexure I : ABG Job Description Template

HayGroup Job Description Template 2017

Basic Details:

Fill the required information about business, unit, location, position, reports to position and date of updation of JD

• Business: Financial Service - HO
• Unit: Aditya Birla Health Insurance Company Ltd
• Location: Thane
• Reports to: Poornata Position Title Manager
• Function: Services Operations
• Department: Ops - FWA
• Designation of the Employee: Manager – Ops- FWA
• Date of writing/updation of JD: 22nd March 2024

Job Purpose:

The purpose of this role includes:

1. To do investigation of the cases referred to FWA team, do the quality check of cases referred to investigation and at additional observation point for investigation allocate case to vendor in a given TAT and take follow up with vendor to cover 3-5 parameter along with supporting investigation documents which will help in taking final decision on claim.
2. FWA manager need to also monitor closely to vendor on quality of investigation, parameters covered during investigation, evidences collected during investigation.
3. Adherence to investigation TAT, vendor involvement with nexus are giving wrong report.

Dimensions:

Business Workforce Number:

• On Roll – 6000+
• Offroll/ Part time – 4000+

Unit Workforce Number:

• On Roll – 6000
• Offroll/ Part time – 4000+

Function Workforce Number:

• On Roll – 800
• Offroll/ Part time - 279

Department Workforce Number:

• On roll – 29
• Off roll - 2

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.

1. Once the claim verification request is received from company, QC manager will study the claim, make additional triggers, refines triggers, to form customize questionnaire according to trigger, to allocate the claim for field investigation.
2. To monitor activity of field officers, to guide them and to get the claim investigated according to trigger and as per protocol, to take daily and timely updates, to maintain updates in our data.
3. To verify/ analyses evidence collected by field officers, to guide them if any rework is needed.

Key Result Areas:

Write the key results expected from the job and the supporting actions for each of these key result areas.

1. Investigation Portfolio Management - assigned Geography
2. Innovative Investigation practices & Fraud prevention measures

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.