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 the Role

The Claims Team is responsible for the dedicated processing and servicing of all health claims for key strategic accounts.

The primary purpose of this team is to deliver streamlined and efficient claims management, ensuring timely resolution and exceptional service tailored to the unique needs of each clients.

By serving as a single point of contact for health claims-related inquiries and processes the team enhances client satisfaction, promotes trust, and drives continuous improvement in service delivery.

The Claims Team is committed to optimizing claims processing workflows, facilitating effective communication with clients, and leveraging insights to enhance the overall client experience while supporting the organization's strategic goals .

Role Responsibilities

Act as a Claims buddy- Manage end-to-end cashless / reimbursement claims of employees. This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, communicating with the end customers and ensuring that claims are processed accurately and efficiently.

Verify Policy Coverage : Review and verify policy details to ensure that the claim is eligible for claims processing according to the terms and conditions of the insurance policy.

Provide Customer Service : Respond to inquiries from customers, and other stakeholders regarding claim status, and any other related queries via call as well as email.

Coordinate with Healthcare Providers / Hospitals and Insurance companies : Communicate with healthcare providers to obtain additional information, and clarify details, (whenever required).

Resolve Issues : Investigate and resolve any discrepancies, errors, or issues that may arise during the processing of claims to ensure timely and accurate resolution.

Work with all internal stakeholders, HR of the account, employees to ensure a great experience to the employee.

Be proactive in doing all communications with the employees on the claims status.

Maintain Records : Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.

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.

Achieve NPS of 90+ in the 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.