Account Management Team Lead

Medi Assist; Karnataka; On-site; INR 500,000 - 700,000; Full time

Job summary

Medi Assist in Karnataka is seeking a customer-focused claims and enrollment coordinator to serve as the first contact for queries related to claims, enrolment, cashless and related policy issues for a multi-policy client.

You will monitor a dedicated mailbox, gather reimbursement forms, liaise with insurers and internal teams to ensure timely settlements, and publish periodic reports to HR and insurers. 2–3 years of experience and MS Office proficiency are preferred.

Qualifications

• 2–3 years of experience in a customer facing role.
• MS Office proficiency.

Responsibilities

• Act as first point of contact for queries related to claims, enrolment, cashless and policy queries.
• Monitor and respond to queries raised to the dedicated mail for the client.
• Collect reimbursement claim forms and ensure reimbursement/Cashless within the defined TAT.
• Coordinate with insurers, PA teams, and accounts to resolve payments and settlements.
• Follow up on dummy claims and void payments with insurers.
• Publish reports on claims, enrolment, and payments to HR and insurers.
• Coordinate with internal and external stakeholders to resolve issues related to claims and enrolment.

Skills

Client orientation

Good communication skills

Problem solving

Interpersonal skills

People management

Tools

MS Office

Job description

Role & responsibilities

Act as first point of contact for all queries related to claims, enrolment, cashless and other queries related to the specific customer policy(multiple policies for a single client having multiple entity)

Responsible for monitoring & responding to all queries raised to a particular mail ID assigned for a specific customer/s

Collection of reimbursement claim forms from customers and ensure reimbursement is done as per the TAT. Liaise with the customer, In-warding / processing, PA teams to ensure closure (reimbursement/Cashless) within the TAT

Follow up with Insurer for dummy claims (mid addition of beneficiaries) and process the claims

• Clear Job IDs created by enrolment team for beneficiaries, clear internal error logs (hospital updation) from backend

Follow up with insurers for clearing the external error logs (beneficiaries not updated in the policy) and ensure beneficiary updated in the policy and the claim is cleared

Follow up for insurance claim number from the insurance office and ensure float is raised and follow up with accounts team for the UTR (settlement) details

• Follow up with insurer for Void payments.

Coordinate with insurer and customer to resolve all concerns related to payments, short payments and all queries pertaining to claims, enrollment, etc.

• Coordinate with Client HR for data updation on monthly basis and follow up with insurer for endorsements
• Visit RO and DO as required for MSMs (Monthly Service Meetings) and discuss and reconcile on the outstanding claims or any other grievance/issues related to claims
• Publish reports with respect to IR calling, information awaited claims to the corporates (HRs) and insurers
• Coordinate with Network team, processing team, PA teams, Agents, insurance company, DO(division office), BO(branch Office) and Doctors to resolve the concerns with respect claims, enrolment etc
• Follow up with Insurers for TPA fees
• Team Management

Preferred candidate profile

• 2-3 years of experience in a customer facing role
• MS Office

Client orientation

Good communication skills

Problem Solving Skills

Interpersonal skills

People management skills