Crm Executive

Medi Assist; Bengaluru; On-site; INR 320,000 - 520,000; Full time

Job summary

Medi Assist in Bengaluru is seeking a detail-oriented professional to manage end-to-end claim processes and reporting. You will handle IR claims follow-up, update daily dashboards, prepare weekly client and broker reports, and maintain escalation and endorsement trackers to keep claims moving within SLA.

Responsibilities include data reconciliation, endorsement updates, online enrollment actions, and preparing comprehensive outstanding reports covering cashless, reimbursement, and domiciliary

Responsibilities

• IR Claims Follow-up and calling report updates with latest status and next steps
• Daily Dashboard Report for outstanding items
• Weekly report preparation for client and broker
• Maintenance of Escalation Tracker with interim responses and follow-ups
• Manual addition/deletion tracker maintenance
• Data reconciliation and arranging endorsements
• Endorsement updates and claim confirmations
• Online enrollment actions to complete processes
• Comprehensive outstanding report covering cashless, reimbursement, and domiciliary claims
• Denial claims review before insurer submission
• Follow-up with insurer on payment bounce claims
• DR & PDA management for claims over 30 days
• Review of error logs for processed claims
• Liability check and outstanding investigations to ensure SLA compliance
• Monthly Claim MIS reporting aligned with client, broker, and insurer timelines
• Coordinating with teams to close and settle outstanding cashless claims
• Preparing cashless claims summary for weekly meetings
• Call management including after-hours and weekends
• Email turnaround with 24-hour response commitment
• Stakeholder meetings with broker, insurer, and client

Job description

Role & responsibilities

• IR Claims Follow-up & Calling Report: Followed up on all pending claims via email and calls. Updated the report with the latest status and defined the next steps for each case.
• Daily Dashboard Report (OS): Working on the daily outstanding dashboard report.
• Weekly Report: Preparing the weekly report to be shared with the client and broker.
• Escalation Tracker: Maintaining the tracker daily. Interim responses are being sent and follow-up calls are being made until all escalations are closed.
• Midterm Addition/Deletion Tracker: Maintaining the manual addition and deletion tracker.
• Data Reconciliation: Reconciling unendorsed data and arranging the necessary endorsements.
• Endorsement Updates & Claim Confirmations: Updating endorsements and confirming deletion claims.
• Online Enrollment: Taking all necessary actions to complete the process.
• Overall Outstanding Report: Preparing the comprehensive outstanding report covering cashless, reimbursement, and domiciliary claims.
• Denial Review: Reviewing all pending denial claims internally for accuracy before sending them to the insurer.
• Payment Bounce Claims: Following up with the insurer to reinitiate failed payments.
• DR & PDA Above 30 Days: Obtaining insurer approval to reject claims pending over 30 days.
• Processed Claims Error Logs: Reviewing and resolving error logs for all processed claims.
• Liability Check & Outstanding Investigation Claims: Following up to ensure investigations are completed and claims are processed within the SLA.
• Monthly Claim MIS Report: On track to share the monthly report with the client and broker by the 1st, and with the insurer by the 5th of the month.
• Outstanding Cashless Claims Follow-up: Coordinating with respective teams to track and ensure the closure and settlement of outstanding cashless claims.
• Cashless Claims Summary: Preparing the overall summary of outstanding cashless claims for the weekly meeting discussion.
• Call Management: Ensuring all calls are answered, including after hours and during weekends.
• Email Turnaround: Ensuring all emails are responded to within 24 hours.
• Stakeholder Meeting: Aligning with the broker, insurer, and client to discuss key claim issues, escalations, operational updates, and next steps.