Expert Claims Operations Leader

2 days ago

Melbourne, Victoria, Australia beBeeClaims Full time $90,000 - $130,000

Our organization is seeking a Senior Claims Operations Consultant to lead and execute the technical and quality capability of our Claims Intake team.

Main Responsibilities
  • Manage escalated decision activities in line with defined process standards, ensuring accurate and consistent results within established service levels.
  • Provide expert support to the CI team in handling declined claims, responding to complex member enquiries, and managing complaints with professionalism and empathy.
  • Act as a subject matter expert in CI systems and processes, providing continuous guidance and coaching to the team.
  • Assist the Senior Manager, Claims Operations in daily workflow allocation, focusing on timely handling of urgent and declined matters.
Main Accountabilities
  • Manage internal escalations and complaints, seeking expert input where required to ensure accurate and timely resolution.
  • Oversee daily workflow allocation, ensuring tasks are distributed evenly to the CI team, and monitor urgent matters to enable real-time issue resolution.
  • Support the Senior Operations Manager in implementing and executing training and development plans, promoting knowledge sharing and skill enhancement.
  • Make and document subjective decisions based on product and policy rules when objective outcomes are not possible, ensuring clear communication and resolution with members.
Techncial Support, Coaching, and Feedback
  • Provide continuous technical guidance, coaching, and constructive feedback to the Claims Intake (CI) team, supporting their growth and development.
  • Support the team in applying logic-driven process standards to determine objective indemnity decision outcomes, and manage declined and withdrawn indemnity decisions directly with members.
  • Proactively manage end-to-end case management within Service Levels, ensuring seamless customer experiences.
Service to Members
  • Provide dedicated contact point for all notifications (incident or claim), supporting members through indemnity decision outcomes.
  • Review, evaluate and process member enquires to appropriate owner, ensuring prompt responses and resolutions.
  • Proactively manage relationships with members, resolving issues and concerns in a professional and empathetic manner.

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