Claims Specialist, Reimbursement Claims

Job detailsAbout PlumPlum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations.Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.About the RoleThe primary job purpose of an Executive Reimbursement Claim Processor is to accurately and efficiently process reimbursement claims submitted by policyholders for medical expenses covered under their health insurance policies. This role plays a critical part in ensuring that policyholders receive timely payments for eligible medical costs incurred.Role ResponsibilitiesProcessing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy.Responsible for the following transactional activitiesScrutiny of reimbursement claimsSubmission to InsurerInforming incomplete documentation requirement to the employeesLiaising with employees in explaining the reason for requirements/plum rejectionsLeading team of claims experts who guides the employees to submit the claimsCollaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submissionCommunicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepanciesMaintaining accurate records of claims processing activities and documentation for audit and reporting purposes.Providing customer service support to address inquiries and concerns related to reimbursement claims.Working with Insurance companies to ensure that eligible claims are paid completely to the end customerRole RequirementsAt least 2 years of experience in customer-facing rolesPast Experience in voice profile would be an added advantageExperience in cashless/ TPAAdditional InfoIt will be 5 days of onsite work.Week-offs will be rotational.It would be rotational shifts.Job detailsAbout PlumPlum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations.Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.About the RoleThe primary job purpose of an Executive Reimbursement Claim Processor is to accurately and efficiently process reimbursement claims submitted by policyholders for medical expenses covered under their health insurance policies. This role plays a critical part in ensuring that policyholders receive timely payments for eligible medical costs incurred.Role ResponsibilitiesProcessing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy.Responsible for the following transactional activitiesScrutiny of reimbursement claimsSubmission to InsurerInforming incomplete documentation requirement to the employeesLiaising with employees in explaining the reason for requirements/plum rejectionsLeading team of claims experts who guides the employees to submit the claimsCollaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submissionCommunicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepanciesMaintaining accurate records of claims processing activities and documentation for audit and reporting purposes.Providing customer service support to address inquiries and concerns related to reimbursement claims.Working with Insurance companies to ensure that eligible claims are paid completely to the end customerRole RequirementsAt least 2 years of experience in customer-facing rolesPast Experience in voice profile would be an added advantageExperience in cashless/ TPAAdditional InfoIt will be 5 days of onsite work.Week-offs will be rotational.It would be rotational shifts.About PlumPlum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations.Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.About the RoleThe primary job purpose of an Executive Reimbursement Claim Processor is to accurately and efficiently process reimbursement claims submitted by policyholders for medical expenses covered under their health insurance policies. This role plays a critical part in ensuring that policyholders receive timely payments for eligible medical costs incurred.Role ResponsibilitiesProcessing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy.Responsible for the following transactional activitiesScrutiny of reimbursement claimsSubmission to InsurerInforming incomplete documentation requirement to the employeesLiaising with employees in explaining the reason for requirements/plum rejectionsLeading team of claims experts who guides the employees to submit the claimsCollaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submissionCommunicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepanciesMaintaining accurate records of claims processing activities and documentation for audit and reporting purposes.Providing customer service support to address inquiries and concerns related to reimbursement claims.Working with Insurance companies to ensure that eligible claims are paid completely to the end customerRole RequirementsAt least 2 years of experience in customer-facing rolesPast Experience in voice profile would be an added advantageExperience in cashless/ TPAAdditional InfoIt will be 5 days of onsite work.Week-offs will be rotational.It would be rotational shifts.About PlumPlum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations.Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.About the RoleThe primary job purpose of an Executive Reimbursement Claim Processor is to accurately and efficiently process reimbursement claims submitted by policyholders for medical expenses covered under their health insurance policies. This role plays a critical part in ensuring that policyholders receive timely payments for eligible medical costs incurred.Role ResponsibilitiesProcessing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy.Responsible for the following transactional activitiesScrutiny of reimbursement claimsSubmission to InsurerInforming incomplete documentation requirement to the employeesLiaising with employees in explaining the reason for requirements/plum rejectionsLeading team of claims experts who guides the employees to submit the claimsCollaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submissionCommunicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepanciesMaintaining accurate records of claims processing activities and documentation for audit and reporting purposes.Providing customer service support to address inquiries and concerns related to reimbursement claims.Working with Insurance companies to ensure that eligible claims are paid completely to the end customerRole RequirementsAt least 2 years of experience in customer-facing rolesPast Experience in voice profile would be an added advantageExperience in cashless/ TPAAdditional InfoIt will be 5 days of onsite work.Week-offs will be rotational.It would be rotational shifts.About PlumPlum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations.Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.About the RoleThe primary job purpose of an Executive Reimbursement Claim Processor is to accurately and efficiently process reimbursement claims submitted by policyholders for medical expenses covered under their health insurance policies. This role plays a critical part in ensuring that policyholders receive timely payments for eligible medical costs incurred.Role ResponsibilitiesProcessing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy.Responsible for the following transactional activitiesScrutiny of reimbursement claimsSubmission to InsurerInforming incomplete documentation requirement to the employeesLiaising with employees in explaining the reason for requirements/plum rejectionsLeading team of claims experts who guides the employees to submit the claimsCollaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submissionCommunicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepanciesMaintaining accurate records of claims processing activities and documentation for audit and reporting purposes.Providing customer service support to address inquiries and concerns related to reimbursement claims.Working with Insurance companies to ensure that eligible claims are paid completely to the end customerRole RequirementsAt least 2 years of experience in customer-facing rolesPast Experience in voice profile would be an added advantageExperience in cashless/ TPAAdditional InfoIt will be 5 days of onsite work.Week-offs will be rotational.It would be rotational shifts.

About Plum

About Plum

Plum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations.

Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.

Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.

About the Role

About the Role

The primary job purpose of an Executive Reimbursement Claim Processor is to accurately and efficiently process reimbursement claims submitted by policyholders for medical expenses covered under their health insurance policies. This role plays a critical part in ensuring that policyholders receive timely payments for eligible medical costs incurred.

Role Responsibilities

Role Responsibilities

• Processing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy.

Processing of reimbursement insurance claims, ensuring adherence to company policies and Terms & conditions of the policy.

• Responsible for the following transactional activities

Responsible for the following transactional activities

• Scrutiny of reimbursement claims

Scrutiny of reimbursement claims

• Submission to Insurer

Submission to Insurer

• Informing incomplete documentation requirement to the employees

Informing incomplete documentation requirement to the employees

• Liaising with employees in explaining the reason for requirements/plum rejections

Liaising with employees in explaining the reason for requirements/plum rejections

• Leading team of claims experts who guides the employees to submit the claims

Leading team of claims experts who guides the employees to submit the claims

• Collaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submission

Collaborating with internal& external stakeholders, such as Onboarding team, endorsements team Account management team to resolve complex claims issues and ensure a seamless claims submission

• Communicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepancies

Communicating with Insurance companies policyholders, and internal departments to gather necessary information and resolve claim discrepancies

• Maintaining accurate records of claims processing activities and documentation for audit and reporting purposes.

Maintaining accurate records of claims processing activities and documentation for audit and reporting purposes.

• Providing customer service support to address inquiries and concerns related to reimbursement claims.

Providing customer service support to address inquiries and concerns related to reimbursement claims.

• Working with Insurance companies to ensure that eligible claims are paid completely to the end customer

Working with Insurance companies to ensure that eligible claims are paid completely to the end customer

Role Requirements

Role Requirements

• At least 2 years of experience in customer-facing roles

At least 2 years of experience in customer-facing roles

• Past Experience in voice profile would be an added advantage

Past Experience in voice profile would be an added advantage

• Experience in cashless/ TPA

Experience in cashless/ TPA

Additional Info

Additional Info

• It will be 5 days of onsite work.

It will be 5 days of onsite work.

• Week-offs will be rotational.

Week-offs will be rotational.

• It would be rotational shifts.

It would be rotational shifts.

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