Health Insurance Claim Head at Cermati.com — United States

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About The Role

Lead the Employee Benefit Insurance After Sale team including Data and Claim team
Responsibilities of After Sale team include processing claims, assist clients with endorsements, documents and data keeping
Oversees insurance claims that are in progress to make sure claim decision come out according to SLA and claim appraisal result is justified according to the agreed TC
Assist clients who are admitted to hospital by coordinating with insurance and hospitals when necessary
Make daily, weekly, and monthly report for claim updates
Customer care helpline – 24 hours
Develop and maintain relationships with insurance companies’ claim departments
Negotiate and appeal rejected claims with insurance
Monitor endorsement process and make sure SLA is achieved
Check and make sure member cards are correct and send them to the clients on time
Assist with client closing process by coordinating with insurance and making sure the policy T and C is as per agreed
Put in place control mechanisms that enable achievement of high levels of customer satisfaction.
Ensure quality and service excellence to clients and 5/5 client satisfaction
Continuously improve current systems and processes
Promote a culture of high performance and continuous improvement that values learning and commitment to quality.
More than 5 years experience as Claim Manager in insurance or brokerage firms
Have good relationships with insurance companies
Excellent in communication, negotiation, and persuasion skills
Strong adherence to SLA and maintaining clients expectations
Able to respond to clients inquiry with lightning speed and accuracy
Strong understanding of insurance terms and conditions and claim appeal process
Background in medicine is preferred but not a must