Employee Benefits Specialist

Purpose Of The Role

Responsibilities

Group Insurance Policy Administration (GMC, GPA, GTL, EDLI)

Coverage Management

• Ensure timely coverage of eligible employees and dependents during policy renewal.
• Add new employees to the policy within 7 days of their Date of Joining (DOJ).
• Timely deletion of exited employees to avoid premium mismatches.
  

Claim Coordination

• Facilitate and track claims (hospitalization, accident, death, etc.) ensuring timely settlement.
• Liaise with insurers, TPAs, and employees for documentation and follow-ups.
  

Query Resolution

• Address employee queries related to coverage, claims, and policy terms within defined SLAs.
  

Invoice Management

• Raise and verify monthly/quarterly insurance invoices.
• Coordinate with finance for timely payments.
  

Data Reconciliation

• Monthly reconciliation of employee data with insurer records.
• Ensure zero mismatches in coverage and premium calculations.
  

Policy Update & Communication

• Communicate policy changes, inclusions/exclusions, and renewal updates to employees.
• Prepare and circulate FAQs, policy summaries, and claim process guides.
• Conduct awareness sessions or webinars for employees on insurance benefits.
  

Claims Handling

• Timely settlement of claims
• Denied Claims: Investigate reasons for denial and coordinate with insurer/TPA for resolution or appeal.
  

Death Claims

• Support nominee/family with documentation and claim filing.
• Ensure compassionate and timely handling of sensitive cases.
  

Data Management & Reporting

• Maintain accurate records of insured employees and dependents.
• Generate periodic reports for management on claim trends, coverage, and costs.
• Support audits and compliance checks with complete documentation.
• Timely and enhanced communication
  

Qualifications

• Bachelor’s degree , Proficiency in HRMS and Excel-based reporting
• Excellent communication and stakeholder management abilities
• 5+ years of experience in employee benefits or insurance administration