Claims Case Manager

1 week ago

Sydney, New South Wales, Australia MetLife Full time
Location(s)- Posting Location: Sydney, New South Wales

  • Country
  • Australia
  • Working Schedule
  • Full-Time
  • Work Arrangement
  • Hybrid
  • Posted Date 11Jun2024
  • Job ID 2862
    Description and Requirements:

Summary of Responsibilities:


To proactively manage and assess a portfolio of Salary Continuance (SCI) claims and TPD claims against the relevant policy/plan design and definitions in line with MetLife's claim philosophy whilst ensuring service level agreements are met.


Principal Responsibilities:

  • Ownership of portfolio and workflow associated with portfolio with the aim of ensuring we're meeting customer requirements.
  • Proactively manage claims end to end in line with the MetLife claims Philosophy
  • Build rapport with customers over the phone by maintaining regular contact, identifying appropriate added support services and liaising with the Strategy & Recovery Team to support customers achieve their goals and return to health
  • Manage all stakeholders expectations to support a seamless customer experience
  • Assess claims against policy terms and explain complex decisions with logical and clear rationale and description of why evidence has been weighted over other evidence
  • Instruct third parties to provide claim assessment support as appropriate to the claim situation and use claim providers in line with an appropriate cost benefit analysis
  • Manage incoming work items in line with service level agreements, department objectives and practices
  • Manage claims within appropriate risk and governance frameworks such as the Life Insurance Code of Practice and act appropriately as MetLife's First Line of Defense for risk issues
  • Ability to recognize, categorize and prioritize work requiring mínimal intervention
  • Ensure all written communication is timely, accurate and professional
  • Create and release claim payments in line with delegated authority & calculate any CPI increases
  • Contribute to the team through special projects when required
  • Ability to adopt and embrace change and best of class: philosophy and championing change within the Claims and wider Operations team
  • Work in a positive, optimistic and balanced way and support the team to complete the daily team workload. Support a positive culture in line with MetLife's cultural values.

Skills, Competencies & Experience Required:

  • Proven ability using the telephone professionally to speak to customers on a regular basis, using a range of questioning and summarizing skills, express empathy and build rapport
  • Previous life claims experience
  • Preferred experience in person centred communication and motivational interviewing
  • Ability to deliver outstanding service levels on a daily basis
  • Ability to work supportively within a team and assist team members with work as needed. To be a committed team player who openly communicates and shares knowledge
  • Embraces change with a view to delivering excellent results
  • A high level of attention to detail
  • Weighing up multiple pieces of information and making a sound judgment.
  • Excellent time management and ability to prioritise work at all times delivering quick outcomes with high accuracy
  • Proven ability to work under pressure in an evolving environment
  • Understand and weigh up motivation to return to work and biopsychosocial factors that affect disability
  • Excellent computing skills and literacy and excellent file note keeping and data capture experience
  • Strong financial calculation skills preferred
  • Medical literacy preferred
  • Passion for helping people and making a difference
  • A caring approach and high personal integrity and honest
  • Clear and concise communication skills. Strong listening skills essential and counselling skills preferred but not essential

Qualifications/Experience Required:

  • Minimum 23 years' experience in managing and assessing a claims portfolio end to end; including both Income Protection and TPD claims
  • ANZIIF (or equivalent) or Tertiary qualifications highly desirable.
  • Strong understanding and working knowledge of applicable regulatory, legislative and Compliance framework applicable such as the Life Insurance Code of Practice.

Personal Attributes:


Positive, optimistic, warm, compassionate, confident, patient, calm, fair, honest, respectful of others, has integrity, open, resilient, strong talker and listener, hardworking, team player, leads by example, encourager, self-motivated, supports change in a positive way, owns their culture.

Takes ownership and where needed, leadership.

What's in it for you?- Flexible & hybrid work arrangements

  • Fantastic employee benefits including health & wellbeing allowance, access to corporate discounts through Perks at Work, additional purchased annual leave, super matching and insurances
  • Access to ongoing professional development, including study support and career progression within a leading global organisation.

Benefits We Offer
Our benefits are designed to care for your holistic wel

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