Claims Executive

Job Description

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, PhonePe RMs,

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

customer’s 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.