Claims Technical Specialist

3 weeks ago

Sydney, New South Wales, Australia TAL Australia Full time

From the millions of Australians we protect, to those that make it happen every day at TAL, people really are what we're all about. We want to grow with you. Achieve with you. And support you to do your best work. That's why we're focused on developing leadership, promoting diversity, rewarding excellence, and retaining great talent.

We're always looking for people who want to go further with us. People who do what's right, aim high, and work smart. Why not discover where we can go?

Job Description

The Claims Technical Specialist is responsible for providing technical advice, guidance and support to the Claims team on technical assessment and case management matters, to assist in reaching desired claims durations and outcomes in line with the terms and conditions of the policy.

A key focus of the role is to optimise assessment quality within the Income Protection, Life, Trauma and TPD portfolios and support Claims Managers to build their capability in line with the TAL claims capability and delegated authority frameworks.

Key Responsibilities
  • Contribute towards a culture of process improvement. Along with the Team Manager, ensure that change initiatives are embedded and that best practices are adopted, while ensuring a best practice approach to claims handling.
  • Contribute to department and company projects as required.
  • Maintain current knowledge of life insurance guidelines, processes and policy changes.
  • Ensure claims handling and service approach reflects industry best practice and TAL processes and policies.
  • Other ad-hoc duties as required.
Technical Support
  • Act as a subject matter expert, responding to Claims Consultant requests and enquiries and to authorise and review claims (and associated benefits payments).
  • Provide adverse decision review and sign off on assessment, which may require referral to internal Claims review body.
  • Support Claims Consultants to use effective communication with customers, treating health practitioners and other stakeholders to drive the best service experience and appropriate claim outcomes for the customer.
  • Support Client Managers and Team Managers in their reporting to funds and attendance at fund meetings/case conferences related to technical claim outcomes as required.
  • Development/ enhancement of claims handling procedures and guidelines as required. Assist with embedment.
  • Review, advise and sign off (within delegation) on policy T&Cs within internal forums, communicating the outcome of approved policy T&Cs within team to ensure understanding/application.
Team Capability
  • Drive processes to support development of technical capability within claims and implement strategies to develop technical skills in line with the TAL claims capability framework resulting in progression of delegated authorities in a timely manner.
  • Coaching Claims Consultants in appropriately executing assessment practices ensuring the timely and quality management of claims. Including completing 'above delegation' and 'within delegation' reviews of individuals work and recording outcomes and opportunities for development.
  • Provide insights into Case Manager technical capabilities for the purpose of performance management and support the Team Manager in development planning for individuals to uplift their capability in line with TAL's capability framework.
  • Deliver training as required.
Compliance
  • Contribute to the implementation of appropriate governance structures and quality assurance to successfully deliver business solutions.
  • Ensure compliance with TAL policies, procedures and guidelines procedures, ensuring claims management is in accordance with the TAL claims philosophy.
  • Adherence to external regulations (eg. Privacy and Life Insurance Code of Practice) and all relevant legislation and industry guidelines.
  • Ensure all interactions with Customers, Advisers and other internal and external stakeholders adhere to TAL's Customer Service Culture through the provision of high-quality, accurate and compliant work.
Qualifications
  • At least 2 years' demonstrated experience in a similar role within Life Insurance or 5 years' experience as a Life Insurance Claims Manager or similar.
  • Experience in coaching and embedding knowledge, including an uplift of skills of case managers.
  • Excellent Knowledge of the Life Insurance Code of Practice, Insurance Contracts Act, Privacy Principles and other relevant legislative or regulative requirements and their application during claims assessment.
  • Ability to identify and develop strategies to overcome barriers in claims assessment and management.
  • Strong written and verbal communication, negotiation and influencing skills.
  • Demonstrated ability to provide excellent customer service to a wide range of clients and stakeholders.
  • Relevant tertiary qualifications in Business, Commerce, Health or Allied Health (desirable).
  • Diploma or Cert IV in Life Insurance, or equivalent (desirable).
Additional Information

At TAL we value diversity in all its forms and are committed to fostering an inclusive and equitable culture for all our people. We encourage Aboriginal and Torres Strait Islander people, individuals from all backgrounds, including those with caring responsibilities, people living with disability, and individuals from the CALD and LGBTQI+ communities to apply. Even if you don't check every box in the criteria above, we encourage you to apply today or get in touch with us here.

To provide you with the best experience, we can accommodate you at any stage of the recruitment process. Simply inform our Recruitment team at any time.

TAL is recognised by the Workplace Gender Equality Agency as an Employer of Choice. We are proud to be a member of Diversity Council Australia and the Australian Network on Disability. For information on our reconciliation journey, take a look at our Innovate Reconciliation Action Plan.

We acknowledge the Traditional Custodians of the Land in which our Head Office is based, the land of the Gadigal people of the Eora Nation, and recognise their deep connections to the land, sea, and culture.
We extend this acknowledgment to the many Traditional Lands that we operate across and pay our respects to Elders past, present, and emerging.

#LI-Hybrid

Everyone at TAL has a responsibility to do the right thing and is accountable for the way they conduct themselves. Our expectations are that you follow the principles set out in our Code of Conduct when you come to work every day. Risk management is everyone's responsibility.

If you are already a TAL employee please apply via the SmartRecruiters button in Workday and navigate to the Employee Portal. This is important to ensure that your application is recorded accurately.

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