Claims Specialist
2 days ago
About PlumPlum 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/ TPAAdditional Info It will be 5 days of onsite work. Week-offs will be rotational. It would be rotational shifts.
-
Health Claim Specialist
4 weeks ago
New Delhi, India iAssist Innovations Labs Full timeJob Description:We are seeking a detail- oriented and experienced Health Claims Specialist to join our team. The ideal candidate will be responsible for accurately processing and adjudicating medical claims in accordance with company policies, industry regulation, and contractual agreements. The Health Claims Specialist will play a crucial role in ensuring...
-
Carrier Claim Specialist
3 weeks ago
New Delhi, India BolsterBiz Full timeCompany DescriptionBolsterBiz is a leading provider of offshoring and outsourcing services based in New Delhi. We specialize in driving business growth, optimizing operational efficiency, and ensuring long-term success. With over 2,000 completed projects and more than 100 clients in the USA, we offer cost-effective solutions with access to expert...
-
Claims Specialist
4 weeks ago
New Delhi, India Howden Full timeJob DescriptionIndustry: General Insurance / Insurance Broking / Insurance Surveyor Location: Mumbai Experience: 12+ years Reporting To: Business Head/Vertical HeadRole Summary The role holder will lead the claims function across all Specialty lines of business, ensuring efficient, compliant, and client-centric claims handling. The role involves strategic...
-
Claims Specialist
4 weeks ago
New Delhi, India Howden Full timeJob DescriptionIndustry: General Insurance / Insurance Broking / Insurance SurveyorLocation: MumbaiExperience: 12+ yearsReporting To: Business Head/Vertical HeadRole SummaryThe role holder will lead the claims function across all Specialty lines of business, ensuring efficient, compliant, and client-centric claims handling. The role involves strategic...
-
Claims Specialist
2 days ago
New Delhi, India EXL Full timeEssential FunctionsReviewing and adjudicating medical claims for payment, determining coverage and appropriate coding and verifying information for accuracy. Evaluate and process claims in accordance with company policies and procedures, as well as to productivity and quality standards. Interprets and processes routine and claims including CMS 1500 and UB04....
-
Claims Specialist
3 weeks ago
New Delhi, India GrayQuest Full timeAbout GrayQuestGrayQuest is India’s leading FinTech innovator in the education ecosystem, transforming the$100B+ education industry through its cutting-edge financial solutions. Our flagship offering—monthly EMI solutions for school and college fee payments—makes education more accessible,affordable, and rewarding for millions of Indian families.We...
-
Claims Specialist
3 weeks ago
New Delhi, India Classic Search Private Limited Full timeRole - Research Sensory & Claims SubstantiationLocation - BangaloreIndustry - Personal Care / Consumer Care/ Household Products / Personal Hygiene/ Cosmetics and BeautyExperience – 4-5yrs in core domainKey Responsibility Areas :-The position will be responsible for the consumer testing program and substantiation/defense of big impact, consumer-relevant...
-
Carrier Claim Specialist
3 weeks ago
Delhi, India BolsterBiz Full timeCompany DescriptionBolsterBiz is a leading provider of offshoring and outsourcing services based in New Delhi. We specialize in driving business growth, optimizing operational efficiency, and ensuring long-term success. With over 2,000 completed projects and more than 100 clients in the USA, we offer cost-effective solutions with access to expert...
-
Claims Specialist
4 weeks ago
New Delhi, India Classic Search Private Limited Full timeRole - Research Sensory & Claims Substantiation Location - Bangalore Industry -Personal Care / Consumer Care/ Household Products / Personal Hygiene/ Cosmetics and BeautyExperience – 4-5yrs in core domainKey Responsibility Areas :-The position will be responsible for the c onsumer testing program and substantiation /defense of big impact,consumer-relevant...
-
Carrier Claim Specialist
3 weeks ago
Delhi, India BolsterBiz Full timeCompany DescriptionBolsterBiz is a leading provider of offshoring and outsourcing services based in New Delhi. We specialize in driving business growth, optimizing operational efficiency, and ensuring long-term success. With over 2,000 completed projects and more than 100 clients in the USA, we offer cost-effective solutions with access to expert...
