Claims Oversight Specialist

**Introduction**:
NGS Staff Benefits
Before you learn more about the job ad, we encourage you to familiarise yourself with our fantastic NGS Staff Benefits page (link below) to understand our offering which includes Additional Leave Entitlements, Personal & Professional Development and Health & Wellbeing Benefits.
About us
We are an award winning, national $16B public offer industry fund focused on the education sector. Click on the video below to learn more
The Role
The Claims Oversight Specialist plays a critical role in supporting and advocating for fund members navigating insurance claims. This permanent, full-time role focuses on managing escalated and declined claims requiring additional oversight, liaising with insurers and insurance administration teams to ensure timely, fair, and compassionate outcomes.
**Key focus areas include**:
Management and Reporting of Claims Operations
Identify requirements and drive process change using staff interviews, document analysis, requirements workshops, surveys, site visits, business process descriptions, business analysis and workflow analysis and other relevant inputs.
Respond to escalations from across the business and partners.
Monitor service standards such as those in the TAL Claims Report and provide feedback to the Head of Service Delivery as required.
Receive delegations from the Head of Service Delivery to lead or support department/team level projects and initiatives.
Claims Oversight & Review
Act as a point of escalation for fund members experiencing challenges with their insurance claims.
Monitor escalated or declined claims to ensure appropriate actions are taken by the insurer or administrator.
Proactively identify claims requiring further intervention or support and provide recommendations for resolution.
Prepare detailed case files, reports, and supporting documentation for claims requiring review by the Claims Review Committee.
Coordinate and facilitate the review process, ensuring clarity of information and adherence to established governance frameworks.
Stakeholder Liaison
Collaborate closely with insurers and insurance administrators to resolve member claims efficiently and fairly.
Build and maintain strong working relationships with key internal and external stakeholders to address systemic claims challenges.
Advocate for fund members while balancing commercial and operational realities.
Reporting & Continuous Improvement
Maintain accurate records and data relating to escalated and declined claims.
Provide insights and reporting on claims trends, systemic issues, and opportunities for process improvement.
Identify patterns or recurring issues and collaborate with stakeholders to implement improvements to claims management practices.
Maintain Stakeholder Relationships & Support BAU Activity
Work with key internal and external stakeholders, to build a continuous improvement environment and support an ongoing programme of change.
Coordinate and monitor activity across external business partners such as Mercer (Administration) for the purposes of improving customer experience.
Support the Head of Service Delivery with analysis and execution of operational initiatives.
You have
Minimum 3-5 years’ experience in insurance claims management, member advocacy, or a related role.
Experience managing escalated claims, declined claims, or complex member interactions.
Knowledge of group insurance products (e.g., life insurance, TPD, income protection).
Exposure to claims governance frameworks or committee processes is highly regarded.
We are a super fund that has an exceptional work culture, provides a diverse offering in developing our people and offer many benefits including leave outside of the legislative requirements and you can be a part of it while earning an attractive remuneration package
Please note that to be eligible for this role, you are required to have permanent Australian working rights and residency.