Health Coach

About This Role

This role is responsible for planning and coordinating operational activities for the organization. It provides support to the team and helps the business achieve success.

Responsibilities

• Manage high disease risk customers/patients over the phone, emails, EMR, and in person if required
• Understand medical diseases and their management protocols, along with program construct details
• Follow/develop a detailed tracking plan as per protocol, considering potential complications
• Coordinate with external customers/patients based on risk triggers, ensuring maximum sensitivity and confidentiality
• Manage all cases on a case-by-case basis, ensuring majority customers/patients adhere to the program construct
• Manage changes and escalations effectively on a case-by-case basis
• Measure program performance with relevant reports at defined frequency
• Report and escalate to management as needed
• Successfully manage relationships with all internal and external stakeholders
• Perform risk management to minimize risks at a customer and portfolio level
• Establish and maintain relationships with third parties/vendors
• Review processes on a timely basis
• Work towards digitization at each stage
• Identify opportunities for improvement based on partner feedback
• Conceptualize new MIS design and delivery
• Publish Dashboards with analysis and insights
• Manage leakage and governance around payment and customer benefit utilization
• Manage internal and external process audits
• Adhere to all regulatory requirements and quickly adapt to regulations

Requirements

• Good knowledge of MS Office and Excel
• Knowledge of DRM processes
• Stay abreast with new processes and suggest improvements
• Understanding of DRM systems (process flow and system fields)
• TAT and expectations management for specialized business handling
• Coordinate with other departments, team members, and management to ensure smooth information flow and resolve recurring issues
• Create and maintain standards/protocols for the DRM team
• Maintain consistent service delivery to ensure client retention and satisfaction
• Identify risks to the company and escalate accordingly
• Execute operational processes in line with defined standards
• Provide inputs for refinement and development of guidelines and procedures
• Publish raised claims with the Claims Team and share positive feedback
• Ensure timely and accurate updation of various documents/reports in compliance with the SOP