Customer Support Specialist

Plum; Bengaluru; On-site; INR 350,000 - 600,000; Full time

Job summary

Plum in Bengaluru seeks a dedicated Claims Servicing Associate to manage end-to-end health claim processing for employees of key strategic accounts. You will verify coverage, coordinate with insurers and providers, respond to inquiries, and maintain detailed records to ensure timely, accurate resolution and high employee satisfaction.

The role emphasizes proactive communication, SLA adherence, and collaboration with HR and internal stakeholders to deliver exceptional service and drive process

Qualifications

• Minimum 2 years of customer-facing experience.
• Voice profiling experience is a plus.
• Experience in cashless/TPA preferred.

Responsibilities

• Act as a Claims buddy- manage end-to-end cashless/reimbursement claims for employees.
• Verify Policy Coverage: review policy details to ensure eligibility for processing.
• Provide Customer Service: respond to inquiries regarding claim status via calls and email.
• Coordinate with healthcare providers/hospitals and insurers for information as required.
• Resolve issues: investigate discrepancies to ensure timely resolution.
• Work with HR and employees to ensure a great experience for the employee.
• Proactively communicate claims status to employees.
• Maintain Records: detailed records of all claim-related activities.
• Adhere to SLAs and performance metrics for claim processing, turnaround time, accuracy, and customer satisfaction.
• Aim for NPS of 90+ in the claims handled.

Skills

Customer-facing

Voice profiling

Cashless/TPA experience

Job description

This role is responsible for the dedicated processing and servicing of all health claims for key strategic accounts. The primary purpose of this team is to deliver streamlined and efficient claims management, ensuring timely resolution and exceptional service tailored to the unique needs of each client. By serving as a single point of contact for health claims-related inquiries and processes, the team enhances client satisfaction, promotes trust, and drives continuous improvement in service delivery. The Strategic Accounts Servicing Team is committed to optimising claims processing workflows, facilitating effective communication with clients, and leveraging insights to enhance the overall client experience while supporting the organization's strategic goals.

Responsibilities

• Act as a Claims buddy- manage end-to-end cashless/reimbursement claims for employees. This includes verifying policy coverage, reviewing medical records, coordinating with Insurers, communicating with the end customers 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 claims processing according to the terms and conditions of the insurance policy.
• Provide Customer Service: Respond to inquiries from customers and other stakeholders regarding claim status and any other related queries via calls as well as email.
• Coordinate with Healthcare Providers/Hospitals and Insurance companies: 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 claims to ensure timely and accurate resolution.
• Work with all internal stakeholders, HR of the account, and employees to ensure a great experience for the employee.
• Be proactive in all communications with employees on the claims status.
• 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 90+ in the claims handled.

Requirements

• At least 2 years of experience in customer-facing roles.
• Past Experience in voice profiling would be an added advantage.
• Experience in cashless/ TPA.