Claims Investigator

5 months ago


Sunshine Coast, Australia Youi Pty Ltd Full time

The role of an Investigator at Youi is focused on conducting thorough and transparent investigations of insurance claims to ensure the best outcomes for both the business and the customers.

**The role involves several key responsibilities**:

- **Triage Claims**: Assess incoming claims to determine whether investigations are required. This involves an initial evaluation to understand the circumstances of the claim and whether an investigation is required to reach the right outcome on the claim.
- **Conduct Investigations**: Investigate claims across various risks to detect and prevent fraud and policy breaches. This likely involves gathering evidence, conducting interviews, obtaining statements from involved parties, critically analysing documentation and information and evaluating policy terms and conditions.
- **Claims Forum**: Present the findings of your investigations at our internal Claims Forum. This will involve sharing your insights, analysis, and recommendations to ensure transparency and informed decision-making.
- **Decision-Making**: Make informed decisions in line with Youi’s Claims Philosophy based on the investigations conducted. These decisions could pertain to the validity of claims, coverage eligibility, and potential actions to be taken.

**About you**:

- **Experience**: Prior experience in conducting interviews, obtaining statements, would be beneficial for success in this role.
- **Presentation Skills**: The ability to present investigation findings confidently at the Claims Forum is important.
- **Knowledge**: Familiarity with Part 15 - Claims Investigations Standards of the General Insurance Code of Practice is crucial for adhering to industry standards.
- **Problem-Solving**: Ability to analyse complex situations, identify issues, and develop solutions is important for conducting thorough investigations.
- **Empathy and Communication**: Effective communication and empathy are essential for interacting with customers, understanding their situations, and conveying decisions.
- **Negotiation Skills**: You might need to negotiate with various parties to gather information, resolve disputes, and ensure fair outcomes.
- **Logical Thinking**: A logical mindset is valuable for analysing evidence, identifying patterns, and drawing sound conclusions.
- **Results-Driven**: A focus on achieving the best outcomes for both customers and the business is key.

**Pros and Cons of the role**:
The best part of the job is working to find a balance between looking after customers' and the company's interests. No two days are the same and this role provides variety and challenges.

On the other hand, one of the challenging aspects is making unfavorable decisions that can have financial implications for customers. This requires a delicate balance between empathy and adherence to policies.

**Consideration**:
The role is mostly remote, with one day per week in the office at Head Office. It also involves managing a portfolio of 15 investigations.

For more information or to express interest, reaching out to Madison Radford is suggested.

This role is suitable for individuals with a background in investigation, strong interpersonal skills, and an understanding of insurance practices, particularly claims investigations. It offers a mix of challenges and rewards, with a focus on fairness and transparency for both customers and the business.

Reach out to Madison Radford with any questions.


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