01Responsibilities
Claims Facilitation & Escalation: Act as a bridge between the sales team, partners, and the central claims team to expedite the processing of pending claims and resolve bottlenecks.
Elite Partner & Customer Support: Provide dedicated support to CEO/CDO/National Head Club agents and customers regarding claim status updates, documentation requirements, and grievance handling.
Claims Documentation & Verification: Ensure all claim documents, medical records, and KYC/AML checks are uploaded, indexed, and verified with 100% accuracy before submission to the central team.
Regulatory & Audit Compliance: Maintain strict adherence to internal and regulatory guidelines for claim reporting and data privacy.
Key Performance Indicator (KPI)
Query Resolution: Significant reduction in pending claim queries and TAT for claim settlement.
Service Excellence: Achievement of target CSAT/NPS scores specific to the claims experience.
FTR (First Time Right): >98% accuracy in claim document collection to prevent rejections or delays.
Audit Compliance: Zero critical errors in claim document indexing and regulatory reporting.
Key Requirements Education & Certificates:
Must be a medical graduate i.e BDS, BPT, BHMS, BAMS, BUMS, etc
Key Requirements - Experience & Skills:
A minimum of 1+ years of experience in a health or medical insurance claims servicing.
Strong knowledge of medical terminology, insurance claim procedures, and billing codes.
Excellent verbal and written communication skills.
Strong problem-solving and decision-making abilities.
Attention to detail and accuracy in data entry and documentation.
Exceptional customer service skills with a friendly and professional demeanor.
Proficiency in using computer systems, including customer relationship management (CRM) software and Microsoft Office Suite.
Ability to work effectively in a team-oriented environment. .
