Claims Case Manager

Location(s)
- Posting Location: Melbourne, Victoria
- Country
- Australia
- Working Schedule
- Full-Time
- Work Arrangement
- Hybrid
- Relocation Assistance Available
- No
- Posted Date
- 30-Jan-2025
- Job ID
- 6263

**Description and Requirements**:
Summary of Responsibilities: To proactively manage and assess a portfolio of TPD claims and Income Protection (IP) claims against the relevant policy/plan design and definitions, MetLife's claim philosophy whilst ensuring service level agreements are met.

**Principal Responsibilities**:

- Proactively manage a portfolio of high complexity disability claims in line with the MetLife claims Philosophy
- Provide proactive customer support by keeping people making a claim updated on the progress of the claim assessment. Manage all stakeholders expectations to support a seamless customer experience
- Build rapport with people on claim over the phone, establishing disability level (and for IP: return to work motivation and return to work plan) and achieve appropriate NPS customer engagement score
- Assess claims against policy contracts and explain complex decision in writing over the phone with logical and clear rationale and description of why evidence has been weighted over other evidence
- Instruct third parties to provide claim assessment support as appropriate to the claim situation and use claim providers in line with an appropriate cost benefit analysis
- Manage incoming work items in line with service level agreements, department objectives and practices
- Manage claims within appropriate risk and governance frameworks such as the Life Insurance Code of Practice and act appropriately as MetLife's First Line of Defense for risk issues
- Ability to recognize, categorize and prioritize work requiring mínimal intervention
- Ensure all written communication is timely, accurate and professional
- Request appropriate evidence of income to calculate usual earnings for employed and self-employed people. Calculate benefit payable against the policy calculation method.
- Create and release claim payments in line with delegated authority & calculate any CPI increases
- Contribute to the team through special projects when required
- Ability to adopt and embrace change and best of class: philosophy and championing change within the Claims and wider Operations team
- Work in a positive, optimistic and balanced way and support the team to complete the daily team workload.
- Support a positive culture in line with MetLife's cultural values.
- Promotion of MetLife's insurance operations internally and externally

**Skills, Competencies & Experience Required**:

- Minimum of 12 months of relevant experience in claims assessment, within the Life Insurance Industry
- Ability to efficiently manage a portfolio of claims holistically to achieve sustainable, timely outcomes and within SLAs and financial services law claims handling provisions and Life Code of Practice
- Excellent proven ability in using the telephone professionally to speak to customers on a regular basis, using a range of motivational questioning and express empathy and build rapport
- Preparing all customer communication, including complex information and adverse decision advice
- Ability to review and complete complex financial calculations
- Ability to deliver outstanding service levels on a daily basis
- Ability to work supportively within a team and assist team members with work as needed. To be a committed team player who openly communicates and shares knowledge
- A high level of attention to detail
- Excellent time management and ability to prioritise work at all times delivering quick outcomes with high accuracy
- Proven ability to work under pressure in an evolving environment
- Understand and weigh up motivation to return to work and biopsychosocial factors that affect disability
- An understanding of life insurance policy conditions and contracts
- Excellent computing skills and literacy and excellent file note keeping and data capture experience
- Clear and concise communication skills

**Qualification Required**:

- ANZIIF (or equivalent) or Tertiary qualifications highly desirable.
- Strong understanding and working knowledge of applicable regulatory, legislative and Compliance framework applicable such as the Life Insurance Code of Practice.

Personal Attributes:
Positive, optimistic, warm, compassionate, confident, patient, calm, fair, honest, respectful of others, has integrity, open, resilient, strong talker and listener, hardworking, team player, leads by example, encourager, self-motivated, supports change in a positive way, owns their culture. Takes ownership and where needed, leadership

**Benefits We Offer**

When you join MetLife Australia, you are joining a company that demonstrates holistic care and wellbeing for employees with benefits and programs that address physical, mental, social and financial health. We offer life insurance benefits, generous paid parental leave, market leading men