Claims Case Manager
2 weeks ago
Location(s)- Posting Location: Sydney, New South Wales
- Country- Australia- Working Schedule- Full-Time- Work Arrangement- Hybrid- Posted Date- 11-Jun-2024- 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 2-3 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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