Cashless Claims Specialist

About Plum

Plum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations.

Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.

Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.

About Job

Claims Management Specialist is responsible for processing and managing cashless insurance claims efficiently and accurately, ensuring timely closure to policyholders and seamless coordination with insurance providers.

The job purpose of a Claims Management Specialist is to process and manage cashless claims for employees. This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently. The processor may also be responsible for communicating with employees or dependents to provide updates on the status of their claims and to address any questions or concerns. Overall, the job purpose is to facilitate the smooth and timely processing of cashless claims to ensure that employees receive the benefits they are entitled to.

Role Responsibilities

1. Act as a Claims buddy - Manage end-to-end cashless claims of employees. This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring that claims are processed accurately and efficiently.
2. Verify Policy Coverage: Review and verify policy details to ensure that the claim is eligible for cashless processing according to the terms and conditions of the insurance policy.
3. Provide Customer Service: Respond to inquiries from employees, and other stakeholders regarding claim status, and any other related queries.
4. Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information, clarify details,( whenever required)
5. Resolve Issues: Investigate and resolve any discrepancies, errors, or issues that may arise during the processing of cashless claims to ensure timely and accurate resolution
6. Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
7. Adhere to Service Level Agreements: Meet or exceed established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.
8. Achieve NPS of 92+ in the cashless claims handled

Role Requirements

• At least 2 years of experience in customer-facing roles
• Past Experience in voice profile would be an added advantage
• Experience in cashless/ TPA

Additional Info

• It will be 5 days of onsite work.
• Week-offs will be rotational.
• It would be rotational shifts.