PhonePe—Claims Executive

Job description

Description: PhonePe Limited (Formerly PhonePe Private Limited) is a technology company that builds digital platforms for Payments, Digital Distribution Services and Financial Services. Headquartered in India, the PhonePe digital payments app was launched in 2016. As of April 2026, PhonePe has over 70 Crore life-till-date registered users and a digital payments acceptance network spread across over 5 Crore merchants. PhonePe’s products and services include Consumer Payments (including Digital Distribution Services), Merchant Payments, Lending and Insurance Distribution services, and New Platforms, which comprise Share.Market (stock broking and mutual funds distribution platform), and Indus Appstore (Android-based mobile app marketplace). Culture: At PhonePe, we go the extra mile to make sure you can bring your best self to work, Everyday!. And that starts with creating the right environment for you. We empower people and trust them to do the right thing. Here, you own your work from start to finish, right from day one. PhonePe-rs solve complex problems and execute quickly; often building frameworks from scratch. If you’re excited by the idea of building platforms that touch millions, ideating with some of the best minds in the country and executing on your dreams with purpose and speed, join us! Role: As a Claims Officer, you will be responsible for the processing and servicing of escalated health insurance claims. Your primary purpose is to coordinate with various stakeholders and meet customers' needs by ensuring timely, appropriate claim settlements. You must be dedicated to improving customer experience through effective problem-solving, acting as a bridge between the customer, PhonePe RMs, and the insurer. Key Responsibilities: ● Act as a Claims Guide: End-to-end management of cashless/reimbursement escalated claims. This includes verifying policy coverage, reviewing medical records, coordinating with insurers, suggesting documents for reconsideration and ensuring that claims are processed efficiently. ● Verify Policy Coverage and Eligibility: Review and verify policy details and nuances of customer’s health to ensure that the claim is eligible for processing according to the terms and conditions. ● Coordinate with Stakeholders: Coordinate with insurers and TPAs to obtain additional information, challenge unfair decisions, clarify details, and drive timely claim resolution. ● Provide Exceptional Customer Service: Serve as the point of contact for resolving customer concerns in escalated claim cases. Ensure all customer-facing communication meets standards of empathy and clarity to enhance the client experience. ● Strategic Reporting & Optimization: Track and report on insurer-wise performance and claim cycle times. Utilize these insights to optimize claims processing and overall experience. ● Experience: 2-4 years in health insurance claims processing. Must have prior experience of working in the insurance/TPA industry. ● Education: Bachelor’s degree in life sciences / pharmacy / medical science / nursing is preferred. ● Display a strong understanding of health insurance claims and related regulations/terminologies. ● Core Skills: Negotiation, Problem-Solving, Attention to Detail, Resilience, and Clear Communication. Key Performance Indicators (KPIs) ● Resolution TAT for Escalated Claims: Measures the speed and effectiveness in resolving claims concerns. This is the primary KPI. ● Customer Satisfaction (CSAT): Measures customer happiness with the handling and outcome of their claim issues. ● Claims Cycle Time (Insurer-wise Analysis): Measures diligence in tracking and reporting on the end-to-end processing time for each insurance partner to identify systemic delays.