Claims Specialist

2 months ago

Melbourne, Australia Chandler Macleod Full time

**Location**
***
- Melbourne, Victoria**Category**
***
- Accounting & Finance**Salary**
- $120000 AUD - $130000 AUD Annual**Posted**
- 08-Aug-2023**Work type**
- Contract**Contact**
- Vedangi More**Reference**
- BH-149364On the hunt for a Claims Specialist (Trustee Reviews) for one of our financial services clients, you will be providing general financial product advice to customers, you will be reporting to the Manager, Claims Assessment, you will be working in the Member & Employer Experience (MEX) - Insurance Operations division.
Working as a member of the team, this role will require specific technical knowledge and skills to determine claim decisions in line with regulatory requirements and timeframes whilst at the same time ensuring Members and beneficiaries feel supported and understood by the organization.

**Accountabilities**:
The role will be responsible for (but not limited to) the following:

- End to end claims management of Defined Benefit claims
- Review insurer Income Protection (IP), Total and Permanent Disability (TPD), Terminal Illness (TI), and death claim decisions in line with the insurance policy and that the decision is a fair and reasonable outcome for the member
- Prepare and present declined claims at the Denied Review Committee meeting
- Determine TPD, TI, Permanent Incapacity (PI) and Terminal Medical Condition of Release (TMCR) approvals under Trustee Delegated authority, SIS and Tax regulations
- Review and where required, collate information from beneficiaries to determine distribution of all death benefits
- Review and sign off requests from the Administrator requiring delegate sign off
- Conduct complex file reviews and provide technical support to the relevant stakeholders
- Manage end to end claims for terminal illness (TI)
- Assist Claims Services Support team to respond to outstanding decision related enquiries
- Present and participate in complex death claims discussions at the Claims Assessments Team committee
- Participate in claims workshops for internal and external stakeholders
- Work to individual and team SLAs to meet Claims Handling requirements and ensure optimal member experience
- Maintain high standard of Quality Assurance results to demonstrate risk and compliance measures maintained
- Build and maintain relationships with third party stakeholders (Insurers and Administrator)
- Proactively identify and support implementation of process improvement
- This role may be required to undertake various other related tasks and/or projects as directed by the Manager, Claims Assessment, Senior Manager, Insurance Services and Head of Insurance Operations from time to time.

**Key Criteria**:

- RG146 Qualification
- Tertiary qualification in a business, commerce, finance, or another related discipline
- Industry experience with an insurer in group life arrangement or fund
- Detailed understanding and knowledge of relevant and current legislation pertaining to superannuation
- Detailed understanding of superannuation regulators and the requirements of organisations complying to Superannuation Industry (Supervision) Act 1994 (Cth) (the ‘SIS’ Act) and Claims Handling
- Well-developed level of written and oral communication skills, including strong analytical skills
- Demonstrated interpersonal skills and the ability to adapt to circumstances
- Ability to work independently, as well as cooperatively and as a member of a team
- Excellent attention to detail and a thorough approach to analysing the circumstances of each assessment
- Demonstrated ability to build and maintain relationships with a variety of stakeholders
- Advanced working knowledge of MS Word, MS Excel, Outlook, and the Internet.

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