Insurance Claims Administrator

Are you a highly motivated individual with a passion for healthcare and a knack for managing teams and data analysis? We are seeking a Claims and Customer Support Manager for our client to lead our dedicated team in handling health insurance claims and improving the overall customer experience.

This role combines customer support, data analysis, and leadership skills to drive excellence in customer service and claims management.

**Responsibilities**:
Claims Management:

- Oversee the processing of health insurance claims, ensuring accuracy, efficiency, and compliance with industry standards and regulations.
- Identify and resolve complex or escalated claims issues, working closely with team members and other departments as needed.
- Determine who the key stakeholders are within your organization and among the insurers. Set up regular meetings or workshops with the relevant parties to streamline the claims process, reduce processing times, improve customer satisfaction, or address specific issues.
- Ensure that all stakeholders have access to the necessary information and documentation related to claims processes, policies, and guidelines. This can include sharing process flowcharts, policy documents, and training materials
- Once you've identified areas for improvement, implement changes collaboratively and monitor the results. Be prepared to make further adjustments as needed
- Keep all parties informed about progress, changes, and improvements. Regular updates can help maintain engagement and demonstrate commitment to the process.
- Implement and maintain quality assurance processes to ensure claims are processed accurately and efficiently.

Team Management:

- Lead and motivate a team of customer support representatives, ensuring they provide exceptional service and meet performance targets.
- Be on top of all customer complaints and escalations. Handhold the team into managing complex customer queries and grievances
- Continuously review and improve customer care processes to enhance efficiency and effectiveness.
- Collaborate with cross-functional teams to implement process improvements and system enhancements.
- Develop and maintain standard operating procedures for the customer care team.
- Handle escalated customer issues and provide resolutions in a timely and satisfactory manner.
- Monitor and analyze customer interactions to identify opportunities for improvement.
- Develop and deliver training programs to enhance the skills and knowledge of the customer care team.
- Ensure that team members are up-to-date with product knowledge and industry trends.
- Conduct regular audits and provide feedback to team members for continuous improvement.

Data Analysis:

- Utilize Excel and other tools to prepare, analyze, and interpret data related to insurance claims.
- Ensure that all stakeholders have access to the necessary information and documentation related to claims processes, policies, and guidelines. This can include sharing process flowcharts, policy documents, and training materials
- Create and maintain monthly information sheets to identify trends in claims, such as common issues or patterns, even frauds.
- Use data insights to recommend and implement process improvements, reducing claims burdens and enhancing the customer experience.

Customer Support:

- Handle escalated customer inquiries or complaints, providing timely and satisfactory resolutions.
- Develop and maintain customer service guidelines and standards to ensure consistency and quality of support.

**Qualifications**:

- Bachelor's degree in a related field (Insurance, Insurance Broking and TPA, Business, or similar).
- 2-3 years experience in customer support in the insurance, Insurance Broking and TPA, Business, or similar
- Strong analytical skills and proficiency in Excel
- Excellent communication and interpersonal skills.
- Should be fluent in English, Kannada, Hindi
- Problem-solving abilities and a commitment to delivering exceptional customer service.
- Knowledge of health insurance policies, procedures, and regulations is a plus.

**Why Join Our Client**:

- Be part of an innovative startup poised to make a significant impact on the healthcare industry.
- Opportunity for career growth and advancement as the company expands.
- Competitive salary and benefits package.
- Collaborative and inclusive work culture.

**Job Types**: Full-time, Permanent

**Salary**: ₹500,000.00 - ₹650,000.00 per year

**Benefits**:

- Health insurance
- Paid sick time
- Paid time off

Schedule:

- Day shift

Application Question(s):

- Would you kindly let us know your current CTC, expected CTC, and notice period?

**Experience**:

- Insurance Claims Processing: 3 years (required)

Ability to Commute:

- Bengaluru Urban, Karnataka (required)