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

1) Job Purpose:Write the purpose for which the job exists (in 2-3 lines) .

2) 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. .

Business Workforce Number
(Max 254 Characters)

On Roll - 7000+

Offroll/ Part time - 4000+

Unit Workforce Number
(Max 254 Characters)

On Roll - 7

Offroll/ Part time - 2

Function Workforce Number .
(Max 254 Characters)

On Roll - 7

Off Roll - 2

Department Workforce Number.
(Max 254 Characters)

On Roll - 7

Off Roll - 2

Other Quantitative and Important Parameters for the job: Budgets/ Volumes/No. of Products/Geography/ Markets/ Customers or any other parameter.

About the Health Insurance Industry -

The Indian health insurance industry has emerged as one of the fastest-growing segments within the broader insurance ecosystem, driven by rising healthcare costs, increasing disease burden, and a growing awareness of financial protection. Since liberalisation in 2000, the sector has expanded significantly, with 30+ insurers (including standalone health insurers, general insurers, and life insurers) now offering health-related products. The pandemic further accelerated adoption, highlighting the need for comprehensive health coverage and preventive care. The industry's gross written premium (GWP) crossed 90,000 crore in FY 2024, accounting for over 35 % of the total non-life insurance market. Regulatory focus by IRDAI on improving product standardisation (e.g., Arogya Sanjeevani), claim transparency, and digital interoperability (through NHCX and Ayushman Bharat Digital Mission) has also enhanced consumer trust and industry maturity.

The sector is now shifting from a pay for illness model to a care for wellness paradigm, integrating preventive health management, digital health ecosystems, and real-time claim settlement platforms. New-age insurers and insurtechs are leveraging AI, data analytics, and machine learning to streamline underwriting, detect fraud, and personalise customer journeys. Distribution has diversified beyond traditional agents and bancassurance to digital marketplaces and embedded insurance models. With penetration still under 5 % of GDP and significant out-of-pocket expenditure (50 % of total healthcare spend), the long-term growth potential remains immense. Going forward, the industry will be defined by innovation, affordability, interoperability, and wellness-centric solutions that make health protection more inclusive, efficient, and value-driven.

About the Aditya Birla Health Insurance -

Founded in 2015 and commencing operations in October 2016, ABHI is a joint venture between Aditya Birla Capital Ltd. (ABCL) and South Africa's Momentum Metropolitan Holdings Ltd (formerly MMI Strategic Investments). Over the years it has rapidly grown its footprint: covering 22 million+ lives, operating across 5,000+ cities, partnering with 20+ bancassurance alliances and engaging 140,000+direct selling agents.

ABHI adopts a distinctive Health First business model - shifting from the traditional buy and forget mindset to one of buy and engage. The company's mission is to proactively help customers build healthier lives by combining insurance protection with wellness programmes, incentivised behaviour (e.g., through the Activ Health suite), and digital experience. The core values emphasise trust, customer-centricity, innovation, and delivering value through prevention and healthy living.

ABHI has made tangible impact in the Indian health-insurance market:

. Expanded distribution capabilities via branches, digital partners, agency network and bancassurance, enabling deeper reach into both urban and semi-urban segments.

. Established a wellness ecosystem (with products like Activ Health and campaigns like #JumpForHealth) that supports chronic-care management and rewards healthy behaviour.

. Attracted significant investor interest: for example, a 655 crore investment by Abu Dhabi Investment Authority (ADIA) for 10 % stake anchored ABHI's valuation at 6,650 crore, recognising its differentiated model and growth potential.

ABHI's purpose centres on making health-insurance meaningful: not just covering hospital bills, but enabling healthier lives, reducing disease burden, and building long-term wellness habits. Its vision is to become India's most desired and innovative health-insurer, delivering protection with a purpose. Through technology, data-driven insights, and digital platforms, the insurer aims to simplify access, speed up claim lifecycle, connect with customers seamlessly and provide value beyond conventional coverage.

In conclusion, ABHI stands out as a modern health-insurer with strong backing, ambitious growth, a wellness-centric philosophy and technology-enabled operations. Its differentiated business model - combining protection, prevention and engagement - positions it to capture rising demand in India's health-insurance segment, while delivering value to customers, partners and stakeholders alike.

Key Challenges for the role -.

• Diverse subject matter: Finance, HR, Compliance, Legal, and Ops processes require fast learning and tailored test design.
• Regulatory sensitivity: Evidence quality must withstand scrutiny for IRDAIlinked areas and external audit reliance.
• Endtoend view: Risks often span multiple functions (e.g., vendor governance touches Procurement, Legal, Compliance, Finance).
• Change velocity: Policy, process, and system changes require dynamic scoping and timely test refresh.
• Influence without authority: Drive agreement on remediation with senior stakeholders using clear evidence and business impact.
• Data Availability & Quality: Continuous auditing requires highquality data feeds from multiple systems. Ensuring timely access, resolving data gaps, and maintaining data integrity are ongoing challenges.
• Designing Effective Analytics: Creating meaningful rules (e.g., fraud indicators, outlier detection, threshold checks) requires strong process knowledge, technical ability, and iterative refinement.
• Managing High Volumes of Alerts: Automated checks can generate large exception volumes. Filtering, prioritizing, and focusing on the highestrisk items is critical.
• Technology & Automation Capability:The role requires comfort with data tools, scripting, and basic automation. Scripts must be reliable - errors can cause false positives or missed red flags.
• Integration with Traditional Audits:CCM must complement, not duplicate, onsite audits. Insights generated should directly inform audit planning and risk coverage.
• Keeping Checks Updated:As products, rules, and processes change, analytics logic must evolve. The check library must remain current and relevant.

Planning & Risk Assessment

• Perform process walkthroughs, identify key risks/controls, define RCMs and test procedures.
• Align scope with regulatory priorities, past findings, and data/issue signals (including CCM insights).

Fieldwork & Testing

• Execute design and operating effectiveness tests (document review, data analysis, reperformance, sample testing).
• Validate financial, compliance, and operational controls (e.g., reconciliations, makerchecker, SLA adherence, duediligence, approvals).
• Maintain complete, wellindexed workpapers supporting conclusions.

Development & Execution of CCM / Offsite Audits

• Design, build, test, and automate data rules/queries/scripts (CCMs) for highrisk processes.
• Collaborate with business owners to understand process logic and potential redflags.
• Use historical data to calibrate thresholds and minimize false positives.
• Document logic, data fields used, and expected outcomes for each check.

Execution and Management of Offsite Audit Program

• Run daily/weekly/monthly automated tests and analyze generated exceptions.
• Conduct detailed verification on material exceptions remove false positives.
• Issue flash alerts for highrisk exceptions (e.g., potential fraud, major process breakdowns). Trigger rapid offsite audits when patterns or anomalies warrant deeper investigation.

Issue Identification & RootCause

• Distill observations into causeriskimpactrecommendation, grade severity consistently.
• Differentiate isolated lapses from systemic themes quantify exposure where feasible.

Reporting & Stakeholder Engagement

• Draft crisp audit observations and executive summaries present to auditees and IA leadership.
• Support the Vertical Head/HIA in finalizing reports and responding to management queries.

Action Plans & FollowUp

• Agree practical remediation with owners, define timelines/owners, and capture evidence of closure.
• Retest fixes for effectiveness escalate overdue critical items.
• Track closure of CCMidentified issues through structured followup.

Collaboration & Continuous Improvement

• Coordinate with IT Audit for systemdriven controls with CCM for dataled signals and repeat exceptions.
• Share best practices and contribute to methodology/SOP improvements.

Use of Technology & Enhancement of CCM Capabilities

• Evaluate and adopt new analytics/automation tools to strengthen CCM.
• Establish secure audit data marts or controlled data environments for testing.
• Continuously enhance CCM scripts to improve accuracy, speed, and coverage.
• Seek input for new checks or enhancements to existing logic.
• Support projects on AI management related to audits

5) Job Purpose of Direct Reports:Describe the job purpose of the direct report/s to the job (in 2-3 lines for each report) .

NA

Relationship Type

Frequency

Nature

Internal

Vertical Head - Functional Audits Team Lead - Offsite Audit HIA Functional Heads (Finance, HR, Legal, Compliance, Ops) Risk & Compliance IT

Regular

Functional

External

External auditors/consultants for specialized reviews (as directed).

ABC - Head of CCM Consultants/Tool Vendors

As and when needed

Clarificatory

7) 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. .

SIGN-OFF:Provide the name of the Manager and the jobholder. Signature needed for the hard copy of the JD. Hard copy to be maintained in the organizational record..

Job Holder

Reports to - Manager

Name

Signature (needed for the hard copy)

Date

________ 2026

________ 2026