Field Claims Executive

About the Role

ClearCover is seeking a compassionate, proactive, and service-oriented Claims Relationship Executive to support insured employees and their families during hospitalization and claim settlement processes. The role requires a combination of field support, hospital coordination, claims facilitation, and stakeholder management to ensure a seamless claims experience for our clients.

The ideal candidate will act as the bridge between employees, hospitals, TPAs, insurers, and corporate HR teams, ensuring timely assistance, issue resolution, and a high level of customer satisfaction.

Key ResponsibilitiesClaims Assistance & Support

• Provide end-to-end assistance for cashless and reimbursement claims under Group Medical Insurance (GMC), Group Personal Accident (GPA), and Group Term Life (GTL) policies.
• Guide employees and their dependents through claim procedures, documentation requirements, policy benefits, and claim timelines.
• Track claim progress and provide regular updates to employees, HR teams, and internal stakeholders.
• Coordinate with TPAs, insurers, and claim processing teams for timely resolution of claims.
• Escalate critical cases and ensure closure within agreed service timelines.

Hospital Coordination

• Visit hospitals, when required, to support employees and their family members during hospitalization.
• Liaise with hospital insurance desks, billing teams, doctors, TPAs, and insurer representatives.
• Facilitate cashless authorization requests and ensure timely approvals.
• Assist in resolving admission, discharge, billing, and documentation-related issues.
• Support employees during emergency hospitalization situations and critical medical cases.

Client & Employee Relationship Management

• Serve as a trusted point of contact for employees and HR teams for claim-related support.
• Address employee concerns with empathy, professionalism, and urgency.
• Maintain strong relationships with hospitals, TPAs, insurers, and client organizations.
• Ensure a positive employee experience throughout the claim journey.

Policy & Benefits Support

• Explain insurance benefits, policy coverage, exclusions, claim limits, and network hospital availability.
• Assist employees in locating network hospitals and understanding treatment eligibility.
• Support onboarding sessions and employee awareness programs on insurance benefits.

Service Excellence & Escalation Management

• Handle claim escalations and service complaints efficiently.
• Coordinate internally to resolve service issues and improve employee satisfaction.
• Identify recurring issues and recommend process improvements.

Reporting & Documentation

• Maintain accurate records of claim cases, hospital visits, escalations, and resolutions.
• Update claim trackers, service logs, and internal MIS reports.
• Submit daily, weekly, and monthly activity reports.
• Ensure compliance with company processes and service standards.

Desired Skills & Competencies

• Strong understanding of health insurance claims and employee benefits.
• Excellent interpersonal and communication skills.
• Ability to handle sensitive situations with empathy and professionalism.
• Strong coordination and stakeholder management abilities.
• Problem-solving and escalation management skills.
• Ability to work under pressure and manage multiple cases simultaneously.
• Proficiency in Microsoft Excel, Word, and email communication.
• Willingness to travel locally for hospital visits and client support.

Qualifications

• Graduate in any discipline.
• Candidates from Insurance Broking, TPA, Hospital Insurance Desk, Healthcare Operations, Claims Processing, or Customer Service backgrounds preferred.
• IRDAI certification will be an added advantage.

Pay: ₹10,500.37 - ₹25,000.00 per month

Work Location: In person