Claims Representative - Field

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

The Cashless Claims Associate provides on-ground support to insured members during hospitalization, facilitating seamless cashless claim processing from admission through discharge. This position requires presence at hospital premises to coordinate between patient, hospital administration, and insurance providers, ensuring efficient claim settlement while delivering superior customer service in accordance with organizational policies and insurance regulations.

Role Responsibilities:

Patient Assistance -

• Provide in-person support to insured members and families during hospitalization
• Verify network hospital status assist with pre-authorization, claim queries, and discharge formalities
• Explain policy coverage, exclusions, and cashless claims process

Claims Coordination -

• Collect required documentation (ID proofs, medical records, discharge summaries)
• Validate billing details and ensure accuracy of pre-authorization approvals
• Monitor claim progress and coordinate enhancement requests

Stakeholder Management -

• Liaise between patients, hospital insurance desks, and insurance companies
• Resolve claim-related disputes and queries promptly
• Escalate cases per established protocols and timelines

Documentation & Compliance -

• Ensure complete and accurate medical documentation collection
• Verify final bills before submission to insurers
• Maintain records of payments and reimbursement-eligible expenses

Feedback Collection -

• Gather patient feedback to improve service quality and the claims process, reporting insights to management.

Role Requirements:

1. 1-2 years in insurance claims with customer-facing responsibilities
2. Proficiency in English, Hindi, and local language
3. Strong communication and negotiation abilities
4. Knowledge of health insurance processes and terminology
5. Mandatory: Two-wheeler with valid driving license