Associate- Cashless Claims Level 2

10 hours ago

Bengaluru Karnataka, India Plum Benefits Full time

**Bengaluru**

**Customer Success - Customer Success /**

**Full Time /**

**On-Site**

**About this role**:

- The job purpose of a Cashless Claims Team Associate 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 dependants 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.

**Roles & Responsibilities-**:

- 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.
- 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.
- Provide Customer Service: Respond to inquiries from employees, and other stakeholders regarding claim status, and any other related queries.
- Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information, clarify details,( whenever required)
- 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.
- 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 92+ in the cashless claims handled.

**Who can Apply-**:

- A minimum of 12 months in a Health Claims role
- Good communication skills (written and oral)
- Past Experience in voice profile would be an added advantage

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