About Plum

Plum is an employee insurance and health benefits platform focused on making health insurance simple, accessible and inclusive for modern organizations.

Healthcare in India is seeing a phenomenal shift with inflation in healthcare costs 3x that of general inflation. A majority of Indians are unable to afford health insurance on their own; and so as many as 600mn Indians will likely have to depend on employer-sponsored insurance.

Plum is on a mission to provide the highest quality insurance and healthcare to 10 million lives by FY2030, through companies that care. Plum is backed by Tiger Global and Peak XV Partners.

JOB PURPOSE:-

- Assistant Manager- Strategic Accounts Servicing team (SAS) Team is responsible for overseeing the dedicated processing and servicing of health claims for key strategic accounts.

- The primary purpose of this role is to ensure streamlined and efficient claims management, delivering timely resolutions and exceptional service tailored to the unique needs of each client who are strategical in nature.

- By serving as a single point of contact for health claims-related inquiries and processes, the Team Manager will enhance client satisfaction, promote trust, and drive continuous improvement in service delivery.

- This role is committed to optimizing claims processing workflows, facilitating effective communication with clients, and leveraging insights to enhance the overall client experience while supporting the organization’s strategic goals.

PRINCIPAL ACCOUNTABILITIES:-

• Manage end-to-end cashless/reimbursement claims of strategic accounts 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.

• Dispute Resolution: Act as the primary point of contact for disputes with insurers, meticulously challenging invalid decisions and advocating for fair resolutions on behalf of clients.

• Verify Policy Coverage for employees: 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: Ensure team is Responding 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, employees to ensure a great experience to the employee. This include hyper management of claims whenever required

• Be proactive in doing all communications with the 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 NPS of 90+ in the claims handled

• 100% retention of all strategic accounts during renewal.

REQUIREMENTS:-

• At least 3-5 years of experience in customer-facing/claims/Operation role

• Excellent verbal and written communication skills for effective interaction.

• Education- minimum graduation