Accident and Health Claims Specialist

2 weeks ago

Sydney, New South Wales, Australia beBeeClaims Full time $80,000 - $110,000

**Your Role**

The primary objective of this position is to deliver high-quality work outputs on accident and health claims through prompt and professional interactions with customers, brokers, and other stakeholders. This involves effective claim investigation, reserving, and adjustment processes.

**Key Responsibilities:**

  • Manage a portfolio of claims for accident and health insurance as allocated and assist in processing retail claims as required.
  • Assess claims in accordance with service level and quality requirements and the general insurance code of practice. This includes determining coverage, reserving within timeframes, making payments, responding to customer queries, providing updates, and requesting additional information as needed.
  • Communicate effectively by telephone and written correspondence to brokers, claimants, and others as required.
  • Participate in claim department and company-wide training as required.
  • Respond to enquiries and escalations of matters from underwriters, brokers, and customers, and work with underwriters, the compliance department, and other departments as needed.
  • Review income replacement claims for payment of periodic benefits at lodgement stage and at key points in the claim cycle and develop strategies for claim management and successful return to work of the claimant where possible.
  • Participate in claims meetings with internal and external stakeholders as required.
  • Manage emergency assistance cases end to end as allocated.
  • Facilitate payment of claims costs and service provider fees including reconciliation and liaison with service providers.
  • Provide advice, instructions, and coaching to service providers as required on claims within delegated authority limits.
  • Monitor performance and processes of service providers to make recommendations in respect of process and contract compliance, escalating breaches to claims management.
  • Assist in daily payment, audit, and other administrative tasks as required.

**Required Skills & Qualifications:**

  • Tertiary qualified or 2-3 years similar work experience.
  • Investigation techniques.
  • Strong written and verbal communication skills.
  • Understanding of insurance contracts.
  • Understanding of legal requirements and regulations.
  • Damage and/or loss evaluation.
  • Negotiation skills.
  • Organisational skills.
  • Reserving skills (desirable).
  • Capable of participating in audits.
  • 1st and/or 3rd party fraud (desirable).

**Benefits & Perks:**

  • Flexible working approach via our initiative.
  • Education assistance.
  • Dress for your day every Friday.
  • Promotion of health and wellbeing.
  • Discounted health insurance.
  • Enrolment into our discounted stock purchasing scheme.

**Equal Employment Opportunity:**

We are committed to equal employment and celebrate individual differences by creating a workplace environment in which everyone feels welcomed, respected, and valued.

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