Latest Jobs at Masslife Healthcare Limited

Job Description

• We are seeking a seasoned, strategic, and passionate Head of Client Service to lead our client-facing operations.
• You will be responsible for defining the strategy, managing high-value relationships, and driving a culture of service excellence across the organization.
• As a senior leader, you will oversee the entire client lifecycle, ensuring high retention, satisfaction, and operational efficiency.

Key Responsibilities

• Strategic Leadership: Develop and implement Client Service strategies that align with business goals, enhance customer experience, and increase retention.
• Relationship Management: Serve as the escalation point for and maintain relationships with key corporate clients and stakeholders.
• Operational Excellence: Supervise the client service department, improving workflows, and ensuring 24/7 responsiveness, including call center performance.
• Team Development: Mentor, coach, and manage a high-performing team of client service executives and managers.
• Quality Assurance: Monitor client satisfaction metrics (Customer Satisfaction Score-CSAT and Net Promoter Score-NPS), analyze feedback, and implement improvements in service delivery.
• Cross-Functional Collaboration: Work closely with the Marketing, Product Development, and Claims departments to ensure seamless service and product alignment.
• Health Promotion: Coordinate with medical teams to organize preventive health programs and wellness initiatives for corporate clients.

Requirements & Qualifications

• Experience: Minimum of 5–10 years of experience in client services, with at least 3 years in a senior leadership role, specifically within a Health Insurance/HMO environment.
• Education: Bachelor’s degree in Business Administration, Healthcare Management, Public Health, or a related field; MBA is a plus.
• Industry Knowledge: In-depth knowledge of health insurance regulations, products, and quality management systems (QMS).
• Skills: Demonstrated ability to lead teams, influence change, and solve complex, high-stakes problems, with technical knowledge of Service-Level Agreements (SLA), client onboarding frameworks, escalation matrices, and compliance reporting.
• Technology: Proficiency in CRM systems, project/collaboration, data analytics, and visualization tools.

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• We are seeking a detail-oriented, analytical Medical Claims Processing Executive to join our growing claims management team.
• The Medical Claims Processing Executive will review, validate, and adjudicate medical claims to ensure accuracy, compliance with policy terms, and timely reimbursement. You will serve as a crucial bridge between healthcare providers, enrollees, and our company to ensure efficient service delivery.

Key Responsibilities

• Claims Adjudication: Review and process medical claims (inpatient/outpatient) in accordance with company policies and legal regulations.
• Documentation Verification: Audit provider bills, ensuring consistency with medical reports, prescriptions, and diagnostics.
• System Utilization: Accurately enter, update, and manage data within our electronic health records (EHR) and claims management software.
• Discrepancy Resolution: Research and resolve discrepancies in claims, including following up on outstanding information from hospitals or members.
• Fraud Detection: Identify and mitigate potential fraud and abuse in claims, implementing effective management practices.
• Customer Support: Handle inquiries from policyholders and providers regarding claim status with professionalism and empathy.
• KPI Management: Meet strict turnaround times (TAT) and quality standards for claim processing.

Requirements & Qualifications

• Education: Bachelor’s degree in Health Information Technology, Nursing, Pharmacy, or a related field.
• Experience: Experience in medical claims processing, medical billing, or TPA roles, medical bill audit, and coding knowledge of ICD-10.
• Technical Skills: Proficiency in MS Office (especially Excel), e-Claims Processing System, data analysis, visualization, and reporting.
• Industry Knowledge: Strong understanding of medical terminology, HMO operations, and insurance plans.
• Skills: Exceptional attention to detail, strong analytical thinking, and the ability to work under pressure.

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We are looking for compassionate, driven, and detail-oriented Health Insurance Call Centre Agents to join our enrollee services team.

The Role

• As a Health Insurance Call Centre Agent, you will be the first point of contact for our enrollees, providers, and prospective clients. You will provide essential support by explaining policy benefits, assisting with claims, and ensuring our members feel heard and supported.

Key Responsibilities:

• Inbound Call Handling:Respond to a high volume of incoming telephone calls regarding policy coverage, benefits, claims status, and billing inquiries.
• Enrollees Support:Assist enrollees in understanding their health insurance plans.
• Problem Resolution:Resolve enrollee complaints and issues in a timely and professional manner, de-escalating tense situations with empathy.
• Documentation:Meticulously log all interactions in our Health Information Management System (HIMS)/Database system to ensure accurate records.
• Provider Liaison:Assist healthcare providers with pre-authorization queries and verification of eligibility.
• Compliance:Strictly adhere to and maintain enrollee health information confidentiality at all times.

Requirements & Qualifications

• Candidate must have Clinical or General Nursing and Health Insurance Call Centre experience.
• Educational Qualification of BSc Nursing (Bachelor of Science in Nursing).
• Strong knowledge of health insurance terminologies.
• Excellent verbal and written communication skills.
• Ability to use multichannel support tools (email, intercom, dedicated communication portals, etc.).
• Good understanding of the helpdesk and call handling (VoIP & Dialer) systems.
• Basic troubleshooting skills (password reset procedures, App Login issue, internet connectivity checks, etc.)
• Proficiency in Microsoft Office Suite and CRM software.
• Ability to work in a fast-paced environment while maintaining close attention to detail.