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Lead Claims Expertise Professional
3 weeks ago
This role is centered around leading and executing the technical and quality capability of a claims team. The primary focus is to ensure that indemnity assessments and decision-making activities are accurate, consistent, and delivered within established service standards.
- Managing escalated decision activities in line with defined process standards, collaborating with key internal stakeholders, and using insights to uplift team knowledge and reduce future escalations.
- Providing expert support to the claims team in handling declined claims, responding to complex member enquiries, and managing complaints with professionalism and empathy.
- Acting as a subject matter expert in claims systems and processes.
- Assisting senior management in daily workflow allocation, with a focus on timely handling of urgent and declined matters.
This role will also be responsible for managing a small portfolio of indemnity assessments and decisions end-to-end.
Key Accountabilities
Operational Process Execution
- 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 claims team.
- Monitor urgent matters and the Notice of Intention (NOI) line to enable real-time issue resolution.
- Support senior operations management in implementing and executing training and development plans.
Technical Support, Coaching, and Feedback
- Provide continuous technical guidance, coaching, and constructive feedback to the claims team to:
- Apply logic-driven process standards to determine objective indemnity decision outcomes.
- Make and document subjective decisions based on product and policy rules when objective outcomes are not possible.
- Manage declined and withdrawn indemnity decisions directly with members, ensuring clear communication and resolution.
- Promote a culture of learning and improvement by offering timely, respectful, and actionable feedback to teams and product.
Service to Members
- Provide dedicated contact point for all notifications (incident or claim) and support member to indemnity decision outcome, building rapport, representing the organization professionally, leveraging our Service Principles throughout all interactions with members.
- Review, evaluate and process member enquires to appropriate owner.
- Proactively manage end to end case management within Service Levels.
Required Skills and Qualifications
- Demonstrated technical expertise with deep understanding of claims process and indemnity assessment.
- Proven ability to coach effectively to process adherence, provide constructive, timely feedback and guidance that supports team learning, builds confidence, and enhances overall capability.
- Strong written and verbal communication, with ability to explain complex decisions clearly.
- Proven ability to work effectively with internal stakeholders and contribute to positive team culture.
- Strong analytical skills and sound judgement in resolving complex or escalated matters
Preferred Skills and Qualifications
- Understanding of Medical Indemnity insurance.
- Understanding of Medico Legal claim types.
- General understanding of medical terminology preferable.
- Experience in coaching or team leadership preferred.
Equal Opportunity Employer
The organization supports healthcare professionals so they can serve diverse communities. Having diversity in our workforce brings valuable perspectives and strengthens our ability to support healthcare professionals.
We therefore welcome applications from people of all backgrounds, including those who identify as LGBTQIA+, people with disabilities, and those with caring responsibilities.
Our inclusive workplace is somewhere everyone can succeed.
We promote a culture of learning and improvement, and we're committed to providing opportunities for growth and development.
Ready to join us? If you're passionate about supporting Australia's healthcare professionals, we'd love to hear from you.
