TM-Provider Network (Thane )
Aditya Birla Capital
Remote
Business
Financial Service - HO
Unit
Aditya Birla Health Insurance Company Ltd
Location
Thane, G-Corp
Poornata Position Number of the job
Reports to: Poornata Position Number
Poornata Position Title of the job (30 characters max)
AM/ DM
Reports to: Poornata Position Title
AVP
Function
Services Operations
Reports to: Function
Services Operations
Department
Ops – Provider Network
Reports to: Department
Ops – Provider Network
Designation of the Employee
AM/ DM – Provider Network
Designation of the Manager
Assistance Vice President – Provider Network
Date of writing/updation of JD
09-July-2026
- Job Purpose: Write the purpose for which the job exists (in 2-3 lines)
- 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.
(Max 254 Characters)
On Roll – 6000+
Unit Workforce Number
(Max 254 Characters)
On Roll – 6000
Function Workforce Number
(Max 254 Characters)
On Roll – 800
Department Workforce Number
(Max 254 Characters)
On roll -
Other Quantitative and Important Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter
- 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 ((Max 3975 Characters)
35+ Health Tech Partners (HTPs) providing OPD and Wellness services with a portfolio size exceeding ?500 Crores.
10+ TPAs managing Group Health Insurance (GHI) business with an overall portfolio of approximately ?3,000 Crores GWP.
Monitoring key business parameters including Loss Ratio (LR), Average Claim Size (ACS), financial performance, service delivery standards, and partner compliance.
The incumbent will serve as the central point of coordination between ABHI and partner organizations, ensuring effective governance, performance management, audit readiness, and business reporting.
- 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)- Maximum 10 KRAs can be updated
Supporting Actions (Max 1325 Characters)
Health Tech Partner (HTP) Governance
- Manage governance framework for 35+ Health Tech Partners providing OPD and Wellness services.
- Monitor adherence to agreed Scope of Work (SOW), SLAs, KPIs, and contractual commitments.
- Conduct monthly, quarterly, and annual governance reviews with partner organizations.
- Review operational, utilization, commercial, and service-performance reports.
- Drive corrective action plans and continuous process improvements.
- Manage and monitor a portfolio exceeding ?500 Crores.
- Manage governance of 10+ TPAs servicing ABHI's Group Health Insurance (GHI) portfolio of approximately ?3,000 Crores GWP.
- Monitor SLA adherence across claims servicing, customer service, pre-authorization, reimbursement, and policy administration processes.
- Review operational performance, turnaround times, and quality metrics.
- Conduct monthly and quarterly business reviews with TPAs.
- Track implementation of agreed action items and governance commitments.
- Ensure compliance with contractual, operational, and regulatory requirements.
- Monitor partner-wise commercial performance and financial outcomes.
- Track and analyze key performance indicators including:
- Loss Ratio (LR)
- Average Claim Size (ACS)
- Utilization Trends
- Cost Efficiency Metrics
- Service Delivery Performance
- Identify adverse trends and recommend corrective actions.
- Support commercial discussions and strategic decision-making through data-driven insights.
- Collaborate with Finance and Business teams for performance reviews.
- Prepare monthly business performance reports for OPD and Wellness Lines of Business.
- Monitor portfolio performance against budgets, targets, and business plans.
- Develop management dashboards covering:
- SLA Performance
- Partner Scorecards
- LR Analysis
- ACS Analysis
- Claims Trends
- Utilization Metrics
- Business Growth Indicators
- Provide management insights and recommendations on portfolio performance and profitability.
- Organize and coordinate monthly, quarterly, and annual governance meetings.
- Prepare governance decks, MIS reports, scorecards, and business review presentations.
- Track action items and ensure closure within agreed timelines.
- Maintain meeting records, MOMs, presentations, and supporting documents.
- Present partner performance updates to senior management and leadership teams.
- Job Purpose of Direct Reports: Describe the job purpose of the direct report/s to the job (in 2-3 lines for each report)
- Governance of 35+ HTPs and 10+ TPAs.
- SLA monitoring and reporting across all partner organizations.
- Monthly LR and ACS reporting.
- Monthly OPD and Wellness P&L reporting.
- Quarterly partner performance scorecards.
- Timely completion of governance reviews and action-item closures.
- 100% audit-ready documentation and governance records.
- 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
Internal
External
NA
- 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.
Job Holder
Reports to – Manager
Name
Signature (needed for the hard copy)