▷ (High Salary) Claims & Insurance Specialist

Before you learn more about the job ad, we encourage you to familiarise yourself with our fantastic NGS Staff Benefits page (link below) to understand our offering which includes Additional Leave Entitlements, Personal & Professional Development and Health & Wellbeing Benefits.

NGS Staff Benefits link: https://ngssuper.elmotalent.com.au/careers/careers/pages/staffbenefits

About us

We are an award winning, national $17B public offer industry fund focused on the education and community sectors.

The Role

This newly created 3-month contract will provide critical support throughout and after the Fund/'s upcoming limited service period (LSP) as NGS transitions administrators Reporting into the Claims Oversight Specialist, you will play a critical role in supporting and advocating for members navigating insurance claims, with a focus on autonomously managing escalated and declined claims requiring additional oversight. Success looks like proactive case management, sound judgment, clear communication and consistent delivery against service standards benchmarked to leading super funds and best in class service industries. This role will extend over the Christmas and New Years period into January.

Key focus areas include:

- Identify and delivering service improvement activity across the business using process improvement methodologies and the application of innovative thinking.
- Identify requirements and drive process change using staff interviews, document analysis, requirements workshops, surveys, site visits, business process descriptions, business analysis and workflow analysis and other relevant inputs.
- Respond to escalations from across the business and partners.

2. Claims Case Management and Review

- Monitor escalated or declined claims to ensure appropriate actions are taken by the insurer or administrator.
- Proactively identify claims requiring further intervention or support and provide recommendations for resolution.
- Prepare detailed case files, reports, and supporting documentation for claims requiring review by the Claims Review Committee.
- Coordinate and facilitate the review process, ensuring clarity of information and adherence to established governance frameworks.
- Collaborate closely with insurers and insurance administrators to resolve member claims efficiently and fairly.
- Build and maintain strong working relationships with key internal and external stakeholders to address systemic claims challenges.
- Advocate for fund members while balancing commercial and operational realities.
- Maintain accurate records and data relating to escalated and declined claims.
- Provide insights and reporting on claims trends, systemic issues, and opportunities for process improvement.
- Identify patterns or recurring issues and collaborate with stakeholders to implement improvements to claims management practices.

You have

- Demonstratable experience in insurance claims management, member advocacy, or a similar role.
- Experience managing escalated claims, declined claims, or complex member interactions.
- In-depth understanding of insurance claims processes, particularly group life and disability products.
- Exposure to claims governance frameworks or committee processes is highly regarded.
- Excellent verbal and written communication skills with a focus on empathy, clarity, and professionalism.
- Strong advocacy skills with the ability to build trust and rapport with fund members.
- Ability to assess escalated claims objectively, identify solutions, and recommend appropriate actions.
- Proven ability to liaise with insurers, administrators, and internal teams to resolve issues collaboratively.
- Proficiency in preparing case files, reports, and documentation for governance purposes.
- Strong understanding of regulatory frameworks and governance processes related to insurance claims.

We are a super fund that has an exceptional work culture, provides a diverse offering in developing our people and offer many benefits including leave outside of the legislative requirements and you can be a part of it while earning an attractive remuneration package

Interested and suitably qualified candidates should submit a copy of their updated CV. We are reviewing applications as we receive them, so apply today to ensure you don/'t miss out on this fantastic opportunity

Please note that to be eligible for this role, you are required to have permanent Australian working rights and residency.

We are an equal opportunity employer committed tocreating a workplace that values diversity, equity, and respect for all individuals.

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