Advisor, Claims Audit

3 weeks ago

Sydney, Australia Australian Reinsurance Pool Corporation Full time

**ARPC Position Description**

**Function**:Claims Assessment & Audit Team **Classification broadband**:ARPC5/6

**Location**:Sydney **Security clearance**:Baseline

**Role Reports to **(role title)**:Executive Manager, Claims Assessment and Audit

**Direct Reports **(role titles)**:nil

**Purpose of the role**
The purpose of this role is to assist the Manager, Claims Audit and Executive Manager, Claims Assessment
and Audit in performing Claims Audits in accordance with the approved processes and procedures._**Key Accountabilities**

**Claims Audit**:

- Review and understand ARPC’s claims procedures and processes.- Work with Manager Claims Audit and Executive Manager Claims Assessment and Audit (and other

resources, as required) to audit and advise on claims paid in accordance with approved guidelines and
approach.
- Participate in cedant engagements to undertake efficient and effective Know Your Customer and

claims file audits in accordance with approved guidelines and approach, to complete reviews as
planned.
- Liaise with cedants to complete the reviews, with Manager Claims Audit reviewing end to end

claims data, including the preparation of any findings or issues raised as part of the cedant claims
review.
- Maintain data integrity within ARPC’s claims management system and processes.
- Raise questions escalate issues with the Executive Manager Claims Assessment and Audit where
- ambiguities or unusual situations arise.- Assist Manager Claims Audit to ensure that all claims’ related matters are dealt within the timeframes
- set out in the Legislation and Reinsurance Agreements.- Identify suspicious or potentially fraudulent claims and notify the Executive Manager Claims
- Assessment and Audit and Executive Manager Claims Fraud Investigations.- Provide data for reports, both internal and external, as required regarding reviews undertaken and key
- activity.- Assist in the understanding of claims issues and risks, recommend, and implement changes
- based on identified inefficiencies.- Review data and undertake analysis of claims paid as required for internal and external

stakeholders.

**Other**:

- Assist the Chief Claims and Customer Officer, Executive Manager Claims Assessment and Audit
- and other members of the claims and customer teams, as required.- Role model ARPC’s Values and Code of Conduct and Capabilities set out in the ARPC’s Capability
- Framework- Maintain and grow knowledge of insurance/reinsurance industry and trends.
- Role model ARPC’s Values and Code of Conduct and capabilities set out in ARPC’s Capability

Framework

***

**Key legislative / regulatory role responsibilities**

**Public Interest Disclosure Act 2013 (PID Act)**:

- ARPC Managers may receive disclosures from staff they supervise or manage and are responsible for
- providing to an ARPC Authorised Officer (CEO, CFO, COO) as soon as practicable, any information
- provided to them that concerns disclosable conduct (within the definition of PID Act S.60A).- ARPC Managers must assist the ARPC CEO (or delegate) and/ or the Commonwealth Ombudsman in

the conduct of a PID investigation.- ARPC staff must assist the ARPC CEO (or delegate) and/ or the Commonwealth Ombudsman in the

conduct of a PID investigation.

**Privacy Act 1988**:

- ARPC staff must adhere to the Australian Privacy Principles and the ARPC Privacy Policy and report
any privacy breaches by any employee or contractor to the Privacy Officer (CFO) and/ or Privacy
Champion (COO) as soon as they become aware of them.

**Freedom of Information Act 1982 (FOI Act)**:

- ARPC staff are responsible for notifying and supporting the Information Public Scheme (IPS) Team to
- ensure published website Information is accurate, up-to-date and complete.- ARPC ‘owners’ of website content are required to review content on their page(s) at least annually.

**Security**:

- Responsible for monitoring their staff (including contractors), resources and functions to ensure
- security controls are maintained and operate effectively.- Responsible to ensure that staff (including contractors) are aware of and practice the appropriate

security procedures for protecting individuals, official information, and other valuable resources.**Working Relationships **(Key stakeholders, clients, customers, suppliers, providers, consultants, etc.)***

**Internal Relationships**:

- Build and maintain strong relationships across ARPC by working closely with the business, particularly
the Cedant Review, Underwriting and Risk Teams

**External Relationships**:

- Build and maintain strong relationships with cedants, vendors and partners.

***

**Person specification**

**Qualifications and experience**

**Qualifications**
- Tertiary qualifications -_Mandatory_
- Insurance Industry (ANZIIF qualifications or accreditations) - _Desired_

**Experience**
- Experience in a similar role in General Insurance Claims, Customer Management and Quality
- Assurance / Audit - _Mandatory_
- Technica

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