Plum - General Manager- Claims Operations

Job Description

General Manager - Claims Operations BengaluruCustomer Success 7. Customer Success / Full Time / On-siteAbout PlumPlum 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 PURPOSEWe are seeking a knowledgeable and experienced General Manager of Claims to be part of our cashless and reimbursement claims team. The incumbent will leverage their deep understanding of insurance to guide the team in navigating complex claims scenarios, ensuring optimal outcomes for our customers.PRINCIPAL ACCOUNTABILITIES

• 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.

INTERACTIONSInternal

• Endorsement team
• Onboarding team
• Products & Engineering
• Other Claims teams
• Support Inbound
• Account Management

External

• Insurance Companies
• TPA claims processing or CRM teams

Who can apply

• 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.

Keyskills :
claims management process improvement data analysis team leadership customer advocacy insurance health insurance transaction management strong analytical skillsclaims processing health claims