Insurance Claims Resolution Professional
1 week ago
Job Summary
">As a Claims Specialist, you will play a crucial role in assisting the Senior Manager - Insurance Services in managing the insurance and claims function of the organization. Your primary responsibility will be to handle Death, Total and Permanent Disability (TPD), Terminal Illness (TI), Permanent Incapacity (PI), and Terminal Medical Condition of Release (TMCR) enquiries.
Key Responsibilities:
- Assist claimants/TPA's with their understanding of the claims process, set the expectation of the service they should receive, manage the claim, and be an escalation point where their claim does not go as planned or they need further assistance.
- Handle enquiries end to end, within service standards, including any follow-up with Administrator/Insurer and provide regular progress updates until resolved.
- Manage claim escalations, including follow-up with Administrator/Insurer and provide regular updates to the Member, until resolved.
- Resolve enquiries within the organization's operational processes, risk appetite, SIS/ATO regulations, Claims Handling, and service standards.
- Support the Insurance Operations brand by proactively interacting with Workplace Services, Advice, and Complaints team.
- Maintain detailed and quality claims documentation and interactions on workflow management system.
- Maintain high standards of Quality Assurance results to demonstrate risk, processes, regulatory obligations, and compliance measures maintained.
- Identify, prepare material, and facilitate focus sessions to assist Workplace Services in their interactions with members.
- Attend Workplace Services meeting as required.
- Participate in regulatory change and process improvement projects, as directed by the Insurance Leadership team.
- Drive a culture of service excellence that focuses on positive claims experience.
- Foster positive relationships with external stakeholders, Administrator, and Insurer.
Required Skills and Qualifications:
- Detailed understanding of superannuation regulators and the requirements of organizations complying to Superannuation Industry (Supervision) Act 1994 (Cth).
- Problem-solving capabilities to improve member experience.
- Well-developed written and oral communication skills, including strong analytical skills.
- Excellent attention to detail.
- Demonstrated ability to build and maintain relationships with a variety of stakeholders.
- Strong organizational skills, including the ability to work under pressure and meet critical deadlines.
- Ability to work independently and cooperatively as a member of a team.
- Advanced working knowledge of MS Word, MS Excel, Outlook.
Benefits:
The successful candidate will have the opportunity to work in a dynamic and supportive team environment, contributing to the growth and success of the organization. They will also have access to ongoing training and development opportunities to enhance their skills and knowledge.
Others:
This is a full-time position requiring a tertiary qualification in a business-related discipline. The ideal candidate will possess excellent communication and interpersonal skills, with the ability to work collaboratively as part of a team. If you are a motivated and experienced professional looking for a new challenge, please submit your application today.
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