Customer service - Claims

Job DescriptionCustomer Service Executive – Claims

Location: Chennai
Employment Type: Full-time
Function: Customer Service / Claims
Experience: 1–3 years in Insurance Claims / Customer Service / Employee Benefits / TPA Operations preferred

About the Role

We are looking for a Customer Service Executive – Claims to be deployed at a client’s premises and serve as the primary point of contact for employees requiring assistance with their insurance claims.

The role involves end-to-end coordination of employee claims, including collecting and verifying claim documents, assisting employees with claim-related queries, submitting and processing claims, following up with the insurer/TPA, and ensuring timely reimbursement and closure.

The candidate should be highly organised, responsive and comfortable handling a large employee population and a high volume of claims while maintaining accuracy and service quality.

Key Responsibilities

• Act as the on-site claims support representative for the client's employees.
• Assist employees with queries relating to medical insurance claims, reimbursement procedures, documentation and claim status.
• Collect claim documents from employees and verify them for completeness, accuracy and eligibility.
• Identify missing or incorrect documents and coordinate with employees for timely submission.
• Prepare and submit claim documents to the insurer/TPA within the required timelines.
• Track claims from submission through processing, approval and reimbursement.
• Follow up proactively with the insurer/TPA on pending, queried or delayed claims.
• Maintain an updated claim tracker/MIS covering submitted, pending, approved, rejected and settled claims.
• Ensure claims are processed and followed up promptly and within agreed turnaround times (TAT).
• Escalate delayed or complicated claims to the appropriate internal/insurance team.
• Maintain proper records of all claim-related communication and documentation.
• Provide regular updates to employees on the status of their claims.
• Handle employee interactions professionally and with appropriate sensitivity, particularly in cases involving hospitalization or significant medical expenses.
• Coordinate with the client's HR/administration team and Sriyah's internal claims team as required.
• Ensure confidentiality and proper handling of employee and medical information.
• Support periodic reporting and reconciliation of claims as required.

Key Skills & Competencies

• Strong customer service and employee handling skills.
• Good understanding of health insurance claims and reimbursement processes.
• Strong document verification and attention to detail.
• Ability to manage multiple claims simultaneously and work under time-sensitive conditions.
• Strong follow-up and coordination skills.
• Good written and verbal communication skills in English.
• Hindi language proficiency is mandatory, as the role involves assisting a diverse employee population.
• Tamil communication skills would be an added advantage.
• Good working knowledge of MS Excel and basic MIS reporting.
• Ability to maintain accurate records and meet defined TATs.
• Professional, patient and service-oriented approach.

Pay: From ₹15,000.00 per month

Benefits:

• Health insurance
• Life insurance
• Paid time off
• Provident Fund

Work Location: In person