Job Description

. Customer Service Operations

Manage end-to-end customer care operations including inbound/outbound calls, emails, and escalations. Ensure timely resolution of customer queries related to claims, pre-authorizations, and policy benefits. Develop and implement service quality standards and monitor adherence to SLAs and TATs. Maintain regular coordination with claims, provider network, and corporate relationship teams for service delivery.

2. Team Management

Supervise, mentor, and motivate the customer care team to deliver superior customer experience. Conduct training sessions to enhance product knowledge and soft skills. Prepare shift rosters and manage workforce planning for optimal coverage.

3. Escalation and Complaint Handling

Handle escalated complaints from customers, hospitals, or corporate clients effectively. Coordinate with internal stakeholders for quick resolution and root cause analysis. Maintain complaint logs and ensure closure within defined timelines.

4. Reporting and Analytics

Generate and analyze customer service performance reports and share insights with management. Track key metrics such as call volumes, response times, customer satisfaction scores, and complaint trends.

5. Compliance and Process Improvement

Ensure adherence to IRDAI and TPA regulatory norms in all customer interactions. Identify process gaps and recommend improvements to enhance efficiency and service quality. Support audits, compliance checks, and documentation requirements.

Key Skills & Competencies:

Strong knowledge of

health insurance processes

,

TPA operations

, and

claims workflow

. Excellent communication and interpersonal skills. Proficiency in CRM tools, MS Excel, and reporting dashboards. Strong problem-solving, conflict resolution, and people management skills. Ability to work under pressure and handle high-volume environments.

Educational Qualification:

Graduate / Postgraduate (Preferred: MBA in Insurance, Healthcare, or Operations). Certification in Health Insurance / TPA operations will be an added advantage.

Experience:

7-12 years

of experience in customer service within the

TPA or Health Insurance industry

, with at least

3-5 years

in a managerial role.
Job Types: Full-time, Permanent

Pay: Up to ₹45,000.00 per month

Benefits:

Health insurance Provident Fund
Work Location: In person