TPA Management:

- Establish and manage relationships with Medical TPA's for outsourced medical testing operations; Execute / renew contracts with TPA's after negotiating costs and agreement terms in coordination with the Legal team

- Set-up, define and communicate SOPs and guidelines for medical testing operations to TPAs; Ensure SLAs and activity wise TATs are clearly understood and agreed by TPAs

- Review and finalize mapping of empaneled Diagnostic Centers in coordination with TPAs; Ensure availability of medical testing facilities for all branches / locations

- Review and monitor TPA service levels and adherence to SOPs on a continuous basis; Ensure TATs for medical registration, uploading medical reports, submission of original reports etc. are maintained

- Plan and organize 'Mystery Shopping' audits at Diagnostic Centers in coordination with branches / divisional offices; Review audit feedback regarding quality of service, adherence to SOPs and escalate issues / lapses with concerned TPAs

- Review and monitor medical pendency cases across branches / divisional offices / channels; Drive closures of pending cases through active follow ups with branch / divisional offices and TPAs

- Review and validate TPA invoices, obtain payment approvals and coordinate with Accounts for processing payments; Ensure all payments are disbursed accurately and on time

Manage Tele / Video Underwriting Operations:

- Establish, set-up and revise SOPs, checklists and scripts for tele / video calling processes (e.g. underwriting / fraud detection, medical test feedback, grievance, renewals, agent verification)

- Collate cases from Underwriting team and plan work allocations to effectively manage tele/ video calling volumes

- Allocate cases and share case data dumps to team members for various calling processes (e.g. underwriting / fraud detection, very high risk, medical test feedback, grievance, agent verification)

-Ensure completion of daily calls and updating of forms / questionnaires in adherence to SOPs and defined timelines; Conduct random audits / checks to monitor quality and effectiveness of tele / video calls conducted by team

- Report and discuss negative findings / fraud cases with Underwriting team; Analyze fraud cases to identify common patterns / trends and provide inputs for revising underwriting norms & guidelines

MIS, Reports & Data Analytics:

- Ensure MIS and reports (e.g. medical pendency, case status trackers, TPA adherence to TAT etc.) are prepared and circulated to internal and external stakeholders (e.g. branches / divisional offices / channels / TPAs) as per prescribed formats and timelines

- Perform data analytics and mining to generate insights regarding risk factors, negative locations, DC feedback etc.; Report and discuss findings with Manger to take appropriate preventive actions to mitigate risks

Support IT Projects & Audits:

- Coordinate with the IT team for new system / module developments, change / enhancement requests and UATs pertaining to the Underwriting function

- Provide data support for all audits (internal, IRDA) and respond to all audit queries and clarifications raised

Team Management:

- Set clear expectations by communicating Tele / Video calling objectives, guidelines, SOPs and timelines to team members. Review performance of team members and provide on-going feedback

- Train the team on conducting effective tele / video calls, identifying & detecting frauds etc.; Provide guidance to team on specific cases, queries and escalations