CRM Executive - TPA

Medi Assist; Mumbai; On-site; INR 250,000 - 360,000; Full time

Job summary

Medi Assist in Mumbai seeks an Executive for JD Account Management to handle client servicing related to claims and cashless processes. The role focuses on ensuring complete documents, timely TAT, and effective communication with corporates and insurers.

You will coordinate with inward, processing, and enrolment teams, respond to queries by phone and email, maintain weekly reports, and escalate issues per the defined matrix.

Responsibilities

• Receive and check claim documents for completeness and advise employees on pending documents.
• Track and control documents to ensure TAT of claims/cards as per SLA.
• Feedback from Insurers and Corporates.
• Additional revenue opportunities from existing Corporates.
• Respond to employee queries via e-mails.
• Maintain weekly reports on claims, queries, and TAT.
• Escalate issues as per the escalation matrix.
• Attend to other assignments as assigned.
• Respond to employee queries via phone.

Job description

JD Account Management- Executive

Job Responsibilities: Client Servicing

• Receive and check claim documents for completeness and advice employees
• regarding pending documents, if any.
• Track and control documents to ensure TAT of claims/cards as per SLA.
• Feedback from Insurers and Corporates.
• Additional revenue opportunities from existing Corporates.
• Respond to queries from the employees of the corporate through e-mails.
• Maintain weekly reports on claims and queries and the TAT of the same
• Escalate issues as per the escalation matrix.
• To attend to any other assignments assigned to you from time to time.
• Respond to queries from the employees of the corporate over Phone
• Maintain weekly reports on claims and queries and the TAT of the same
• Escalate issues as per the escalation matrix.
• To attend to any other assignments assigned to you from time to time.

Transactional Activities:

• To coordinate with inward team for claim receiving and claim registration
• Allocating new generated claims to processing team for action
• Liasoning with enrolment team to register the policy for cashless and reimbursement
• Coordination with regional agents, customers for claim related queries, settlement
• queries- cashless /reimbursement
• Answering incoming calls of all customers / agents / internal team
• Keep track of all customer queries with claim numbers and follow-up to verify that
• all queries are resolved.
• Coordinating with cashless / pre auth team to ensure cashless is granted within
• TAT and to provide timely claim status. Query letter / Settlement letter should be
• explained properly to customers / agents on queries and deductions.