Domestic Health Insurance Claims Executive
- Team Vertex Cosmos
- 0 - 5 years
- Pune
- 7 days ago
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Job Description
Job description
Position: Claims Officer
Transcom is Hiring! Health Insurance claims Executive (Day Shift Premium Process)Are you passionate about helping people protect their health and future?
*Role & responsibilities
Role: As a Claims Officer, you will be responsible for the processing and servicing of escalated health insurance claims. Your primary purpose is to coordinate with various stakeholders and meet customers' needs by ensuring timely, appropriate claim settlements. You must be dedicated to improving customer experience through effective problem-solving, acting as a bridge between the customer, and the insurer
Key Responsibilities:
- Act as a Claims Guide: End-to-end management of cashless/reimbursement escalated claims. This includes verifying policy coverage, reviewing medical records, coordinating with insurers, suggesting documents for reconsideration and ensuring that claims are processed efficiently.
- Verify Policy Coverage and Eligibility: Review and verify policy details and nuances of customers health to ensure that the claim is eligible for processing according to the terms and conditions.
- Coordinate with Stakeholders: Coordinate with insurers and TPAs to obtain additional information, challenge unfair decisions, clarify details, and drive timely claim resolution.
- Provide Exceptional Customer Service: Serve as the point of contact for resolving customer concerns in escalated claim cases. Ensure all customer-facing communication meets standards of empathy and clarity to enhance the client experience.
- Strategic Reporting & Optimization: Track and report on insurer-wise performance and claim cycle times. Utilize these insights to optimize claims processing and overall experience.
Ideal Candidate:
- Experience: 2-4 years in health insurance claims processing. Must have prior experience of working in the insurance/TPA industry.
- Education: Bachelors degree in life sciences / pharmacy / medical science / nursing is preferred.
- Display a strong understanding of health insurance claims and related regulations/terminologies.
- Core Skills: Negotiation, Problem-Solving, Attention to Detail, Resilience, and Clear Communication.
Key Performance Indicators (KPIs)
- Resolution TAT for Escalated Claims: Measures the speed and effectiveness in resolving claims concerns. This is the primary KPI.
- Customer Satisfaction (CSAT): Measures customer happiness with the handling and outcome of their claim issues.
Claims Cycle Time (Insurer-wise Analysis): Measures diligence in tracking and reporting on the end-to-end processing time for each insurance partner to identify systemic delays.
Shift: Day Shift Process: Health Insurance Premium Sales Salary: Competitive
6 days wroking 1 rotational week off
Location: Office Address: Transcom: Office No 1501, 1508 15th Floor, Nyati Enthral Sr.no. 12/1A, Mundhwa-Kharadi Bypass, Kharadi South Main Road, Kharadi, Pune, Maharashtra 411014
CONTACT PERSON - HR Gayatri 7447667***
Email ID:-g**********i@tr*****m.com
Role: Customer Success Associate Industry Type: BPM / BPO Department: Customer Success, Service & Operations Employment Type: Full Time, Permanent Role Category: Customer Success EducationUG: Any Graduate PG: Any Post graduate
Job Classification
Industry: BPM / BPOFunctional Area / Department: Customer Success, Service & OperationsRole Category: Customer SuccessRole: Customer Success AssociateEmployement Type: Full timeContact Details:
Company: Team Vertex CosmosLocation(s): Pune
Keyskills: Claims Insurance Claims TPA Insurance
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Team Vertex Cosmos
Transcom is a global customer experience (CX) provider, offering services like customer care, sales, technical support, and content moderation, with a focus on supporting fast-growing brands in the e-commerce, tech, and internet space. Transcom WorldWide AB is a Swedish outsourcing company which pr...
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