Claim Ops Level - L3 L4

Acko; Bengaluru; On-site; INR 900,000 - 1,500,000; Full time

Job summary

Acko in Bengaluru is seeking experienced professionals for Claims Operations (L3/L4) to drive operational excellence and customer experience across health and insurance claims. The role focuses on escalation management, partner coordination and process improvements with technology-led solutions.

Ideal candidates will have strong claims knowledge, analytical capabilities and the ability to analyze feedback, reduce resolution times and improve NPS through systematic optimization.

Qualifications

• Extensive experience in health/medical insurance claims operations.
• Strong understanding of medical terminology, diagnosis, and hospital billing.
• Experience in OPD/IPD, cashless and reimbursement claims.

Responsibilities

• Escalation & Grievance Management: resolve customer escalations and grievances within defined TATs.
• Partner Management: coordinate with internal stakeholders for timely claims resolution.
• Customer Experience & NPS: analyze feedback to drive NPS improvements.
• Process Automation & Improvement: identify automation opportunities and work with Product/Tech teams.
• CX Query Reduction: reduce inbound queries via proactive communication and self-service.
• Operational Excellence: monitor metrics and standardize processes across claims operations.

Skills

Escalation management

Customer handling

Stakeholder management

Analytical thinking

Problem solving

Communication

Process improvement

NPS improvement

Tools

MS Excel

MIS reporting

Data analysis

Job description

Job Description:

About Job

We are looking for experienced professionals for Claim Operations (L3/L4) who can drive operational excellence, customer experience, partner management and process improvements. The candidate should have strong insurance claims knowledge, analytical capabilities and the ability to manage escalations, improve NPS and drive technology-led operational efficiencies.

Skills & Qualification

• Medical qualifications such as B.Sc. Nursing, B.Pharm, BPT, BHMS, BAMS or equivalent will be preferred.
• relevant experience in Health Insurance, Travel Insurance, General Insurance, TPA or Healthcare Claims Operations.
• Strong understanding of medical terminology, diagnosis, treatment procedures and hospital billing.
• Good knowledge of insurance policy terms, coverage, exclusions, admissibility and claim assessment.
• Hands-on experience in OPD, IPD, cashless and reimbursement claims.
• Strong expertise in escalation management, grievance resolution and partner management.
• Excellent analytical, problem-solving and decision-making skills.
• Proficiency in MS Excel, MIS reporting, data analysis and performance monitoring.
• Strong communication, stakeholder management and customer-handling skills.
• Understanding of process automation, digital transformation and technology-led solutions

Responsibilities

1. Escalation & Grievance Management: Own and drive timely resolution of customer escalations and grievances, ensuring adherence to defined TATs and identifying recurring issues to prevent repeat escalations.

2. Partner Management: Manage partner queries and escalations, ensuring effective coordination with internal stakeholders and timely resolution of claims-related concerns.

3. Customer Experience & NPS: Drive claims NPS improvement by analysing customer feedback, identifying pain points and implementing initiatives to enhance the overall claims experience.

4. Process Automation & Improvement: Identify opportunities for process automation, reduce manual interventions and collaborate with Product and Technology teams to implement technology-led solutions.

5. CX Query Reduction: Identify key drivers of customer queries and drive proactive communication, process improvements and self-service solutions to reduce inbound query volumes.

6. Operational Excellence: Monitor key operational metrics, drive process standardisation, improve turnaround times and ensure consistent service delivery across claims operations.

Requirements: