Customer Service

Job Description

Responsibilities:

1. Act as a claims buddy: Manage end-to-end cashless/reimbursement claims of 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.
2. 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.
3. Provide customer service: Respond to inquiries from customers, and other stakeholders regarding claim status and any other related queries via call as well as email.
4. Coordinate with healthcare providers/hospitals and insurance companies: Communicate with healthcare providers to obtain additional information, and clarify details, whenever required.
5. Resolve issues: Investigate and resolve any discrepancies, errors, or issues that may arise during the processing of claims to ensure timely and accurate resolution.
6. Work with all internal stakeholders, HR of the account, employees to ensure a great experience to the employee.
7. Be proactive in doing all communications with the employees on the claims status.
8. Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
9. 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.
10. Achieve NPS of 90+ in the claims handled.

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