Voice Process Specialist

The Strategic Accounts Servicing Team is responsible for the dedicated processing and servicing of all health claims for key strategic accounts. The primary purpose of this team is to deliver streamlined and efficient claims management, ensuring timely resolution and exceptional service tailored to the unique needs of each client. By serving as a single point of contact for health claims-related inquiries and processes, the team enhances client satisfaction, promotes trust, and drives continuous improvement in service delivery. The Strategic Accounts Servicing Team is committed to optimising claims processing workflows, facilitating effective communication with clients, and leveraging insights to enhance the overall client experience while supporting the organisation's strategic goals.

Responsibilities:

• 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.
• 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.
• 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.
• Coordinate with Healthcare Providers/Hospitals and Insurance companies: Communicate with healthcare providers to obtain additional information and clarify details (whenever required).
• Resolve Issues: Investigate and resolve any discrepancies, errors, or issues that may arise during the processing of claims to ensure timely and accurate resolution.
• Work with all internal stakeholders, HR of the account, and employees to ensure a great experience for the employee.
• Be proactive in doing all communications with employees on the claims status.
• Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
• 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.
• Achieve an NPS of 90+ in the claims handled.

Requirements:

• At least 2 years of experience in customer-facing roles.
• Experience in voice profiling would be an added advantage.
• Experience in cashless/TPA.