Assistant Manager- Reimbursement

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:-

- The Assistant Manager in the Insurer Pod will lead a dedicated team responsible for managing all interactions with insurance companies concerning reimbursement claims after submission.

- This role is crucial in ensuring the effective processing of claims, fostering strong relationships with insurers, and facilitating timely resolutions for any issues that arise.

- The Assistant Manager will oversee claim follow-ups, monitor performance metrics, and implement best practices to enhance team efficiency and accuracy.

- Additionally, the incumbent will provide guidance and support to team members, driving a culture of continuous improvement and high service standards.

- By coordinating cross-functional efforts and leveraging industry knowledge, this role will ensure that reimbursement processes are streamlined, ultimately contributing to the organization’s financial health and client satisfaction.

PRINCIPAL ACCOUNTABILITIES:-

• Team Leadership: Oversee and manage the Insurer Pod team, providing direction, support, and motivation to ensure high performance in processing and managing reimbursement claims.
• Claims Management: Supervise all interactions with insurance companies to ensure effective communication and resolution of reimbursement claims submitted for settlement.
• Claims operations management- responsible for the following:-

- Monitor claims stage movement – API and Non API

- Manual stage update for non API

- Review and raising of queries with employees

- Review of query documents submitted and uploading to Insurers 

- Responding to all queries from Claims care and other stakeholders

- Validation and Analysis: Review and validate insurance company decisions regarding claim rejections, deductions, and queries, ensuring compliance with company policies and industry regulations.

• 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.
• Performance Monitoring: Track and analyze key performance metrics related to claims processing and team effectiveness, identifying areas for improvement and implementing strategies to enhance efficiency.
• Client Relationship Management: Maintain strong relationships with various stakeholders, including insurance representatives, to ensure effective communication and satisfaction throughout the claims process.
• Reporting and Documentation: Prepare and maintain accurate records of claims interactions, disputes, and resolutions, providing regular updates to senior management on team performance and claims outcomes.

REQUIREMENTS:-

• At least 3-5 years experience in processing/operation roles
• Past Experience in claims would be an added advantage
• Qualification- minimum Graduation