Claims Resolution Specialist
2 days ago
We are seeking a skilled Claims Resolution Specialist to manage claim work items, ensure compliance with Service Level Agreements (SLAs), and adherence to business rules and regulations.
- Manage claim work items within agreed SLAs, communicate potential SLA risks for corrective action.
- Accurately manage own claim portfolio, ensuring compliance with SLAs and adherence to business rules, life code, SIS Act, and super code regulations.
- Perform quality assurance tasks, conduct end-to-end claim reviews, and provide coaching to administrators to address quality gaps.
- Report incidents within SLA timeframes and assist with incident remediation when requested.
- Own complex enquiries raised internally and externally, ensuring they are answered within agreed SLAs.
- Provide subject matter expert input for Standard Operating Procedures (SOPs) and ensure all actions are completed within agreed timeframes.
- Support complaint management activities with internal and external stakeholders related to Insurance Claims and RG271.
- Collaborate on training sessions for the claims administration team, ensuring effective planning, organization, and delivery to meet learning objectives.
The ideal candidate will have strong knowledge of SLAs, regulatory compliance in insurance claims, and training capabilities. Strong communication and organizational skills are also essential.
In this role, you will have the opportunity to develop your skills and expertise in claim resolution, while working in a dynamic and supportive team environment.
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