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, 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

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

The SLA & Commercial Governance Manager will be responsible for end-to-end governance of Health Tech Partners (HTPs) and Third-Party Administrators (TPAs), ensuring adherence to contractual obligations, service level agreements (SLAs), commercial performance metrics, operational excellence, and regulatory compliance.

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 - 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

The role will oversee governance of:

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.

4) 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

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.

TPA Governance (Group Health Insurance)

• 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.
• 
  

Commercial Governance & Business Performance

• 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.
• 
  

Monthly Business Reporting & P&L Monitoring

• 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.
• 
  

Governance Reviews & Meeting Management

• 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.
• 
  

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)

• 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.

Relationship Type (Max 80 Characters)

Frequency

Nature (Max 1325 Characters)

Internal

External

NA

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)