1. Risk Assessment & Technical Underwriting • Evaluate Group Profiles: Analyse corporate demographics, past claim experience (if available), and industry-specific health risks. • OPD Product Structuring: Design and customize OPD sub-limits (e.g., capping pharmacy vs. dental vs. diagnostics) based on client requirements and budget. • Pricing Strategy: Utilize actuarial inputs and burning cost models to determine sustainable premiums for high-frequency outpatient perks.
2. Portfolio Management • Loss Ratio Monitoring: Regularly track the performance of the OPD portfolio to identify accounts with high "leakage" or over-utilization. • Renewal Analysis: Lead the underwriting for policy renewals, recommending adjustments in pricing or coverage terms based on historical data.
3. Stakeholder Collaboration • Sales Enablement: Support the sales and broking teams by providing technical justifications for quotes and participating in high-value client meetings.
• Network Coordination: Work with the Wellness and Network teams to ensure that OPD cashless facilities align with the underwritten risk.
4. Compliance & Process Excellence • Filing & Documentation: Ensure all customized corporate quotes adhere to IRDAI guidelines and internal Product Filing (GTC) benchmarks.
Key Performance Indicators (KPIs)
1. Loss Ratio (LR) and GWP influx: Maintaining targeted GWP influx and maintaining the OPD portfolio LR within the budgeted threshold. 2. Quote TAT: Delivering technical quotes within the defined internal Service Level Agreements (SLAs). 3. Retention Ratio: Percentage of profitable corporate accounts successfully renewed. Compliance: Zero deviations from the internal Underwriting Authority Matrix.