Claims Associate

Job Summary

As a Claims Associate, you'll own the end-to-end claims experience for our clients employees - from the first query to final resolution. You'll be the primary point of contact between employees, insurers, and TPAs, making sure claims move quickly, documentation is accurate, and escalations are resolved before they become churn risks.

Responsibilities

• Communicate with employees on claim status, process, and requirements.
• Explain the claims process clearly, over email, call, and in conversation.
• Follow up on and verify claim documentation for completeness and accuracy.
• Assist employees in filling out claim forms correctly the first time.
• Track claim status end-to-end and proactively update employees.
• Coordinate with TPAs/insurers to push claims through and resolve queries.
• Translate insurer/TPA queries into plain language for employees, and guide them on how to respond.
• Manage and resolve claims-related escalations.
• Collect claim feedback to identify process gaps.
• Ensure on-time settlement of reimbursement claims.

Why This Role

• Own the end-to-end claims experience for our clients employees.
• Work directly with employees, insurers, and TPAs to drive timely claim resolution.
• Play a key role in resolving escalations and ensuring a smooth employee experience.
• Identify process gaps through claim feedback and contribute to improving the claims experience.

Requirements

• 3-10 years of experience in a claims role, ideally with a broking firm, TPA, or insurer.
• Strong oral and written communication skills, with the ability to explain claims processes clearly and effectively.
• Strong working knowledge of group health insurance, including GMC policy terms and conditions.
• End-to-end knowledge of processing both cashless and reimbursement claims.
• Good understanding of how TPAs and insurance companies operate, including claims coordination and query resolution.
• Empathy and patience when handling employee queries, concerns, and escalations, with the ability to work effectively in a fast-paced, multitasking environment.
• Good Excel skills and strong attention to detail are a plus.

Job Type

Full time

Location

Karnataka, India

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.