Health Insurance Organizations - Essay Example

Health Insurance Table of Contents Introduction 3 Functions of Organization 4 The Vision and the Mission ment 5 Organizational Culture 6 Monitoring 7 Organizational Chart 8 Conclusion 10 Bibliography 11 Appendix – Organizational Chart 12 Introduction The world around us is changing quite fast. The life has become fast paced like never before and the word ‘change’ is considered as the only constant thing in the present scenario of today. With the massive developments in the fields of information technology and communication process, the world has become real small place to live in. As the lifestyle has changed significantly, the hazards of the changing lives have also increased. Among the rising concerns, health is regarded as one of the prime issues. The age old saying rightly says that the ‘health is wealth’. One can expect to perform as per his or her potential only if he or she is physically and mentally fit. But the rising cost of health care has been a matter of concern all across the globe. It is truer in United States of America. In order to curb the rising cost of health ailments, health insurance has come up as a major alternative. As it happens in insurance, the cost gets shared among the customers who agree to pay a certain sum of regular premium that transfers the risk of the speculated happening to the insurer. Health insurance companies primarily offer wide range of health care plans and the customers are supposed to choose from the plans that best suit them. The risk initiation and the amount of premium depend upon such chosen plans. Functions of Organization The functions of the organization in the sector of health insurance predominantly depends upon the factors like the mission and the vision statements of the organization, the target group of customers that the company caters to and the structure of the governing body. The target group of customers for the leading health insurance companies in the United States of America involves those in the middle age groups and those professionally independent. The group that has recently acquired job can also well be targeted. With the present reforms initiated by the administration of United States that calls for increased private share in the health related expenditure, the markets for the health insurance company would further open up. The apt governing structure should have an efficient CEO&MD (Chief Executive Officer and Managing Director) at the top. The CEO&MD should be sufficiently experienced in this field of business. The top boss could be followed by various Executive Directors for the domains of Marketing, Finance, Sales, Risk Management, Human Resources, Legal and Operations. The Executive Directors could have managers based upon channels or geographical locations. The governing council should ideally comprise of the positions of the Executive Directors. Along with the internal positions, external professionals should also be inculcated into the governing council like that of independent doctors or the directors from the hospital chains. A professional actuary from the insurance sector should also be an integral part of governing council. The Vision and the Mission Statement The vision statement refers to the reason of existence of the organization. The mission statement of the organization basically covers the long term goals of the organization. The basic constituents of the vision of an ideal health insurance company include: To improve the health care system and increase the well being of the population and the communities Quality health care in affordable price Getting increased number of people within the protection of health care plans especially that of those with in the economically backward classes The mission statement primarily comprise of the ways that are instrumental in achieving the vision of the company. The mission of the health insurance company includes that of: The management of the health insurance company should relentlessly build up the connections that matters the most and that should ideally include the concerned quarters like that of hospitals, clients, governments and regulators. The health insurers should be able to transform the information into insight. The information about the trends and the syndromes of the industry should be successfully inculcated into care plans. In the modern world of today, the customer is undoubtedly the king. The crux of the success of the company lies in allowing the customers having greater access to alternatives. This helps in empowerment of the customers and they feel themselves to be the integral part of the organization. The company should have enough alternatives for its customers. Organizational Culture The organizational culture plays crucial role in determining the success of any organization. It is the culture that sets the system in place for any company. The ideal health insurance company in the United States should have the following important features: Simplicity – The entire system of the health insurance should be kept simple by the companies. The customers should be able to choose the befitting pan without any hassle. Affordable – The pricing should be affordable with respect to the target group of customers. The company should aim to provide quality medical prevention to the customers in affordable cost. Customization – The health insurance company should have wide array of plans and schemes from which customers can choose the best fitting plan. Customization should be provided with utmost importance. Network – The health insurance providers should have strong network of branches so that the customers can easily locate the service provider. It would invariably help in ensuring more business. Knowledge Sharing –The health insurance providing company can provide knowledge assistance to the valued customers. As the organization would have large pool of experts in their panels, they could provide much required guidance to the customers. Customer Support – Customer support has become integral part of any successful organization. The customers should be able to reach the company in the time of need and so, they should have dedicated support team. Organizational culture basically facilitates the mission and vision of the company. The middle managers play the instrumental role in making the organizational culture successful. In order to do so, the authority should be delegated to the managers along with the power. They should also be made accountable to their superiors. There should be effective reward management to encourage the performers like high incentives or promotion to superior positions. Monitoring It can be analyzed from the discussion above that the organizational culture holds the supreme importance for any health insurance service provider. Though, the company can try its best to implement all of its cultural values, but it might so happen that the managers or those in-charges can often get deviated from the laid down cultures. Therefore, proper mechanism of monitoring the implementation of organizational culture is a must. The number of satisfied customers can be a source of information if the organizational cultures are followed in the best possible way. The attrition rate among the employees and the number of repeat customers are some of the other mechanisms. It has been observed that the organizational culture should not always be set by the top management and also it should not be formal always. Rather, the top management should allow the middle level managers and the team to develop the best suited organizational culture. The only thing that it is to be regarded is that the organizational culture should serve the vision, mission and objectives of the company. Organizational Chart The organizational chart depicts the level of hierarchy within an organization. It also states the responsibility, authority and accountability of the employees. The organizational chart can be as follows: CEO&MD – The health insurance organization should ideally be led by a full time chief executive officer who have considerable amount of experience in the domain of health insurance. Executive Directors – The CEO should be followed by the executive directors who would be in independent charge of various functions like that of marketing, sales, finance, risk management, legal and operations. General Managers – There could be many general managers under one executive director. For example, under executive director (sales), a general manager could be allocated for each type of plans or schemes. Regional Managers – Regional managers should be based upon the geographical locations i.e. the regions. They should ideally report to the general manager and supervise the branch actions. Branch Managers – The branch managers would have the independent charge of the branches and they would oversee all the happenings in their assigned branches. Branch Managers would be accountable to the Regional Managers. Managers – A branch under the leadership of a Brach Manager would comprise of various managers like that of Sales Managers, Marketing Managers, Operations Managers and Finance Managers among others. Executives – The managers should have a team under their purview. Executives could well comprise the team and help in getting the required business. Advisors – The advisor would be the ultimate persons for the sale of the insurance plans to the prospective clients. They might not be on the pay rolls of the company can be contracted on the basis of commissions and incentives. The organizational charts of a health insurance company would not be completed without an actuary or professional experts like that of doctors and medical practitioners. Conclusion The importance of organizational culture along with the well defined vision and the mission statement is instrumental in the success of any organization. It is same for any health insurance company too. The vision and the mission help to identify the reason of existence and the long term goal of the organization. The other important aspects include the organizational culture and the well defined organizational hierarchy through the organizational chart. Along with these factors, the effective risk management and involvement of leading professional experts would ensure the success of the health insurance company. Bibliography Aetna, (No Date). Products and Services. Individuals & Families. Retrieved Online on March 28, 2010 from http://www.aetna.com/plans-services-health-insurance/overview/index.html BCBS, (No Date). Investment in America’s Health. About BCBSA. Retrieved Online on March 28, 2010 from http://www.bcbs.com/about/foundation/ Cameron, K. S. & Quinn, R. E., (1999). Diagnosing and Changing Organisational Culture. University of Michigan. Retrieved Online on March 28, 2010 from http://webuser.bus.umich.edu/cameronk/CULTURE%20BOOK-CHAPTER%201.pdf United Health Group, (No Date). Missions & Values. About. Retrieved Online on March 28, 2010 from http://www.unitedhealthgroup.com/AboutUs/MissionAndValues.aspx United Health Group, (No Date). How We Do It. Approach. Retrieved Online on March 28, 2010 from http://www.unitedhealthgroup.com/AboutUs/OurApproach.aspx Appendix – Organizational Chart The organizational chart drawn is indicative and not extensive. CEO Exe Dir (Marketing) Exe Dir (Sales) Exe Dir (Fin) Exe Dir (HR) Exe Dir (Legal) Exe Dir (RM) GM-1 GM-2 GM-3 GM-4 RM-1 RM-2 RM-3 RM-4 BM-1 BM-2 BM-3 Manager-1 Manager-2 Manager-3 Executive-1 Executive-2 Executive-3 Advisor-1 Advisor-2 Advisor-3 Read More