Senior Claims Executive

2 days ago

Melbourne, Victoria, Australia beBeeClaims Full time $100,000 - $145,000
Claims Leadership Role

This position oversees the Claims Intake team, ensuring that technical and quality capabilities are developed and executed within established service standards.


Key Responsibilities
  • Lead escalated decision activities in line with defined process standards, collaborating with internal stakeholders, and using insights to improve team knowledge and reduce future escalations.
  • Provide expert support to the Claims Intake team in handling declined claims, responding to complex member enquiries, and managing complaints with professionalism and empathy.
  • Act as a subject matter expert in Claims systems and processes.
  • Assist the Senior Manager, Claims Operations in daily workflow allocation, focusing on timely handling of urgent and declined matters.

Operational Process Execution
  • Manage internal escalations and complaints, seeking expert input where required for accurate and timely resolution.
  • Oversee daily workflow allocation, ensuring tasks are distributed evenly to the Claims Intake team.
  • Monitor urgent matters and the Notice of Intention (NOI) line for real-time issue resolution.
  • Support the Senior Operations Manager in implementing and executing training and development plans.

Technical Support, Coaching, and Feedback
  • Provide continuous technical guidance, coaching, and constructive feedback to the Claims Intake 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  • Manage declined and withdrawn indemnity decisions directly with members, ensuring clear communication and resolution.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 Claims Intake and Claims Excellence Teams and Product.

Service to Members
  • Offer dedicated contact points for all notifications and support members through indemnity decision outcomes, building rapport and representing the organization professionally.
  • Review, evaluate and process member enquires to appropriate owners.
  • Proactively manage end to end case management within Service Levels.

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