Page 27 - Insurance Times October 2019

RISK MANAGEMENT

IN HEALTH

INSURANCE - THE

WAY FORWARD

M anaging risk in health care and health Market is fiercely competitive and every health insurance

insurance plays a seminal role in protecting
company is vying each other to take away other's pie and
the interest of policyholder, distribution and
share of market so companies are highly concentrating on
of course companies itself.
claim management which involves legal tangle also since
people are becoming more and more knowledgeable and
People cannot predict the timing and health care expenses they know how to get the claim through Ombudsman,
required during treatment and hospitalisation including cost Consumer Court, IRDAI and other legal accessories which
of operation for which they buy health policy preferably companies are usually averse of getting into. It has direct
cashless health policy which is meant for saviour to them
bearing on market goodwill and certainly sales get affected.
during the time of crisis.
The Role of Risk Managers
Major risk is borne by of course the company where they
Y Identify risk in system or potential risk
undertake the risk of payment to the policyholder in case
of any eventualities happens in rare case they repudiate the Y Analyse and evaluate risk in systematic manner
claim on the ground of pre-existing disease, suppression of Y Develop a well defined approach of risk management
facts or any other clauses which is duly mentioned in the
policy schedule as exclusion clause. Y Implement the system in place
Y Monitor the system ineffective manner
It is imperative that in the health care or health insurance
Y Compare, be suggestive and receptive to any new
organisation it should have qualified risk managers to
identify, assess, develop, implement and monitor the risk innovative ideas
management process within the well-defined spectrum of Y Involve the employee, salespeople, even agents,
minimizing the risk exposure keeping in mind safety, patient experts to reduce and balancing risk
care and mostly management of finance and image of the
Y Assimilate and integrate different departments to
company since goodwill of the health insurance, its business develop a full proof mechanism.
and presence in the market depends how fast they settle
the claim within the stipulated time frame. Y Integrate the sales management process and the
managers involve with the claim management process
About the author Y Educate and train the people time to time the whole
gamut of system so that every people rather all the
Bilwa Banerjee department run in tandem and align every one into
Sr. Manager one objective that is reduction of cost and better
Reliance Nippon life insurance profitability not harming the patient's interest and
maintaining goodwill.

The Insurance Times, October 2019 27