Customer Support Executive

About the Role

The Strategic Accounts Servicing Team focuses on dedicated handling and servicing of health claims for key strategic accounts. The team aims to streamline claims management by ensuring timely resolution and providing excellent customer service tailored to the distinct requirements of each client. Acting as a single contact point for health claims inquiries, this role enhances client trust and satisfaction while fostering continuous improvement in service delivery. The team also optimizes claims processing workflows and maintains effective communication with clients to support the organization's strategic objectives.

Key Responsibilities

• Serve as a Claims buddy by managing the full lifecycle of cashless and reimbursement claims, including verifying policy coverage, reviewing medical documentation, coordinating with insurers, and communicating effectively with customers to ensure accurate and efficient claims processing.
• Review and confirm policy coverage to validate claim eligibility following insurance policy terms and conditions.
• Respond to customer and stakeholder inquiries regarding claim statuses and related matters via phone and email.
• Collaborate with healthcare providers, hospitals, and insurance companies to gather additional information and clarify claim details when necessary.
• Investigate and resolve discrepancies or errors that arise during claims processing to ensure prompt and accurate resolutions.
• Work closely with internal teams including HR and employees to ensure a positive experience throughout the claims process.
• Proactively communicate claims statuses to employees keeping them informed at every step.
• Maintain comprehensive and accurate records of all claim-related actions, communications, and transactions for auditing and documentation purposes.
• Consistently meet or surpass service level agreements related to claim processing, turnaround times, accuracy, and customer satisfaction.
• Achieve a Net Promoter Score (NPS) of 90 or higher for claims handled.

Candidate Requirements

• Minimum of 2 years experience in customer-facing roles.
• Previous experience in voice-based customer support is advantageous.
• Familiarity with cashless claims processing or Third Party Administrator (TPA) systems preferred.

Additional Information

• Work schedule includes 5 days onsite at Bengaluru (Whitefield) location.
• Rotational week-offs will be observed.
• Rotational shifts are part of the work routine.