Associate- Cashless Claims Level 2 Job in Bengaluru at Plum

Open is hiring for the role of Senior Software Engineer - Flutter!

Responsibilities of the Candidate:

• 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, and 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.

Requirements:  

• A minimum of 12 months in a Health Claims role
• Good communication skills (written and oral)
• Past Experience in a voice profile/customer-facing role required