Plum 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.
Insurer Liaison Manager – Claims Resolution is a dedicated, on-ground role responsible for resolving complex and long-pending health insurance claims that cannot be closed through regular remote coordination with insurers.
The role is based full-time at the insurer's claims processing office and is specifically focused on claims that have breached TAT, remain unresolved beyond SLA, are stuck as escalations, or involve unique, grey-area, or high-level cashless cases. The Insurer Liaison Manager works directly with the insurer's processing and decision-making teams to drive these cases to closure.
The role requires strong knowledge of health insurance policy terms, conditions and medical terminology, along with a customer-first mindset. The role holder will be expected to deep-dive into complex claim scenarios, interpret policy and medical information accurately, and bring multiple stakeholders—including insurers, Plum Operations, clients/HR teams and hospitals—onto the same page to arrive at a fair, swift and well-reasoned resolution.
Handle Unique / Grey-Area / High-Level Cashless Escalations: Work on cashless claims involving unclear policy interpretation, unusual case specifics, complex scenarios, or cases requiring senior insurer sign-off. Coordinate directly with the relevant processing and decision-making teams to resolve these cases.
Apply Claims Interpretation with a Customer-First Mindset: Use in-depth knowledge of health insurance policy terms, conditions and medical terminology to interpret cases fairly and accurately, ensuring genuine claims are evaluated appropriately rather than rejected solely on technicalities or overly narrow interpretations of policy terms.
Deep-Dive into Complex Claims: Review policy wording, medical records and claim history for complex, ambiguous or high-value claims. Clearly communicate the case details to insurers, Plum Operations, client/HR teams and hospitals and align all stakeholders towards a swift and well-reasoned decision.
Escalate Insurer Non-Responsiveness: Flag cases to the Claims Operations Lead where the insurer remains non-responsive beyond the agreed threshold, such as 3 working days, even after in-person follow-up.
Maintain Accurate Records: Maintain daily/weekly records of all stuck cases handled, including closures, ageing trends, status and blockers, and report these to the Claims Operations Lead.
Excellent written and verbal communication skills, with the ability to coordinate effectively with insurers, Plum Operations, clients/HR teams and hospitals.
Locations: Hyderabad
This is a full-time, on-site role at the assigned insurer's claims processing office.
The role will require working independently with minimal daily supervision.
Periodic travel may be required as part of the role.
