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
