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Plum - General Manager- Claims Operations

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Plum

12d ago

  • Job
    Full-time
    Expert Level
  • Customer Relations
    Healthcare

AI generated summary

  • You need 15 years in health insurance and 8-10 years in claims operations, a relevant degree, strong analytical skills, leadership abilities, and expertise in cashless and reimbursement claims.
  • You will lead claims operations, manage daily processing, improve efficiency, resolve errors, share knowledge, enhance transparency, and analyze data for continuous improvement in service delivery.

Requirements

  • 15 years of experience required in health insurance - either in an Indian or International insurer.
  • A minimum of 8-10 years of claims operations experience in health claims.
  • Bachelors degree in Business, Insurance, or a related field.
  • Extensive experience in Health Insurance claims management/operations, particularly in cashless and reimbursement claims.
  • Strong analytical skills with a proven ability to conduct detailed case analyses and data-driven decision-making.
  • Excellent communication and interpersonal skills, facilitating effective collaboration with internal teams and external partners.
  • A strong understanding of insurance policies, terms, and conditions, with experience in dispute resolution.
  • Proven leadership skills, with a focus on developing and motivating teams for high performance.

Responsibilities

  • Leadership and Guidance: Provide expertise and direction to the cashless and reimbursement claims team, drawing upon extensive insurance knowledge to enhance team performance and service delivery.
  • Manage the end-to-end operations for Claims: Manage daily operations for both Cashless and Reimbursement. The focus will be on daily productivity, efficiency improvement, process improvement, team adherence, and SLA adherence with partners.
  • Transaction Management: Oversee and monitor daily transactions related to claims processing, ensuring adherence to quality standards and operational efficiency as the claims leader.
  • Product improvement: Design process changes required to improve efficiency via automation, process re-engineering etc. Liaise with the Plum product team for getting these implemented.
  • Knowledge Sharing: Promote a culture of knowledge sharing across cross-functional teams, simplifying the payout process and educating stakeholders on claims procedures and best practices.
  • Error Resolution: Identify processing errors by TPA & insurer and raise them swiftly and get them fixed. Act as an advocate for customers by disputing grey area claims with insurers, utilizing a thorough knowledge of insurance terms and conditions to drive favourable outcomes. Raise disputes for decisions regarding medical understanding or terms interpretation, document gaps etc., and help the Dispute team with all relevant details.
  • Performance Transparency: Assist clients in understanding claims performance and service statistics regularly, enhancing transparency and trust in the claims process.
  • Data Analysis and Process Improvement: Engage in continuous data analysis to identify trends and inefficiencies in the claims process, implementing improvements to enhance quality, efficiency, and overall service delivery.

FAQs

What is the job title for this position at Plum?

The job title is General Manager - Claims Operations.

Where is the job located?

The job is located in Bengaluru.

What are the main responsibilities of the General Manager - Claims Operations?

The main responsibilities include managing the end-to-end operations for claims, overseeing cashless and reimbursement claims, providing leadership to the claims team, managing error resolution, and promoting process improvements.

What is the required experience for this position?

A minimum of 15 years of experience in health insurance is required, with at least 8-10 years specifically in claims operations.

What educational qualifications are needed for this role?

A bachelor’s degree in Business, Insurance, or a related field is required.

Does the role involve working with external partners?

Yes, the role involves interactions with insurance companies and TPA claims processing or CRM teams.

What skills are essential for this position?

Essential skills include strong analytical skills, excellent communication and interpersonal skills, a strong understanding of insurance policies and dispute resolution, and proven leadership abilities.

Is prior experience in Indian health insurance necessary?

Experience in either Indian or international health insurance is acceptable.

What are the key goals for the General Manager - Claims Operations?

The key goals include ensuring optimal claims outcomes, improving operational efficiency, enhancing team performance, and increasing transparency in the claims process for clients.

How does this position contribute to Plum's mission?

This position contributes by enhancing claims operations, ensuring high-quality service delivery, and supporting the mission to provide accessible health insurance to a wider population.

Money, motivated. The smart money app helping +1.5m invest, save and manage their spending.

Finance
Industry
51-200
Employees
2016
Founded Year

Mission & Purpose

Plum is a company that offers an AI-powered personal finance app designed to help users manage their money effectively. The app analyses users' financial transactions, provides insights into their spending habits, and offers personalised recommendations to help them save, invest, and achieve their financial goals. Plum's ultimate mission is to democratise access to financial expertise and tools, making personal finance simple, accessible, and automated for everyone. Their purpose is to empower individuals to take control of their finances, build healthy financial habits, and make informed financial decisions with ease. Plum aims to remove the complexity and barriers often associated with financial management, providing users with the tools and knowledge to improve their financial well-being and secure their financial future.