Manager Claims Audit

**ARPC Position Description
**Role title**:Manager Claims Audit & Investigation
**Function**:Claims and Customer Office **Classification broadband**:EL1
**Location**:Sydney **Security clearance**:Baseline
**Role reports to**:Executive Manager, Claims Assessment and Audit (EMCAA)
**Direct reports**:TBD

**Purpose of the role**
The purpose of this role is to assist in the development then management of the Claims Audit and Investigation process
in accordance with the approved guidelines and approach.

**Key accountabilities**

**Claims Audit and Investigation**:

- Review and understand ARPC’s claims policies and processes.- Initially work with the Executive Manager Claims (and other resources as required) to build ARPC’s Audit and
- Investigations guidelines and approach, then look for continuous improvement once implemented.- Direct cedant engagements to undertake an efficient and effective audit and investigation of claims paid in
- accordance with approved guidelines and approach.- Supervise the resources required to complete reviews as planned. This may involve actively undertaking the
- reviews as required.- Liaise with cedants to complete the reviews, managing the review engagement end to end, including the
- reporting of any findings or issues raised as part of the cedant claims review.- Maintain data integrity within ARPC’s claims management system.
- Raise questions escalate issues with the EMCAA where ambiguities or unusual situations arise.
- Ensure that all claims related matters are dealt within the timeframes set out in the Legislation and Reinsurance
- Agreements.- Identify suspicious or potentially fraudulent claims and notify the EMCAA.
- Arrange investigation and liaise with legal counsel if further action needs to be taken.
- Provide reports, both internal and external, as required regarding reviews undertaken and key activity.
- Assist in the understanding of claims issues and risks, recommend and implement changes based on
- identified inefficiencies.- Review data and undertake analysis of claims paid as required for internal and external stakeholders.

**Other**:

- Assist the Chief Claims and Customer Officer, Executive Manager Claims Assessment and Audit and other
- members of the claims and customer team as required.- Role model ARPC’s Values and Code of Conduct and Capabilities set out in the ARPC’s Capability
- Framework- Maintain and grow knowledge of insurance/reinsurance industry and trends

Role model ARPC’s Values and Code of Conduct and capabilities set out in ARPC’s Capability Framework**Working relationships**
**Internal relationships**
- Build and maintain strong relationships with the ARPC team, in particular the Cedant Review, Underwriting and

Risk teams
**External relationships**:

- Build and maintain strong relationships with Cedants, vendors and partners

**Regulatory responsibilities**
**_Public Interest Disclosure Act 2013_** **(PID Act)

***
- ARPC Managers may receive disclosures from staff they supervise or manage and are responsible for providing to

an ARPC Authorised Officer (CEO, CFO, COO) as soon as practicable, any information provided to them that
concerns disclosable conduct (within the definition of PID Act s60A).
- ARPC Managers must assist the ARPC CEO (or delegate) and/ or the Commonwealth Ombudsman in the conduct

of a PID investigation.
- ARPC staff must assist the ARPC CEO (or delegate) and/ or the Commonwealth Ombudsman in the conduct of a

PID investigation.
**_Privacy Act 1988 _**:

- ARPC staff must adhere to the Australian Privacy Principles and the ARPC Privacy Policy and report any privacy

breaches by any employee or contractor to the Privacy Officer (CFO) and/ or Privacy Champion (COO) as soon as
they become aware of them.

**_Freedom of Information Act 1982_** **(FOI Act)****:

- ARPC staff are responsible for notifying and supporting the Information Public Scheme (IPS) Team to ensure
- published website Information is accurate, up-to-date and complete.- ARPC ‘owners’ of website content are required to review content on their page(s) at least annually.

**Security**:

- Responsible for monitoring their staff (including contractors), resources and functions to ensure security controls
- are maintained and operate effectively.- Responsible to ensure that staff (including contractors) are aware of and practice the appropriate security

procedures for protecting individuals, official information, and other valuable resources.

**Person Specification
**Qualifications and experience**
**Qualifications**
- Tertiary qualifications - _Desired_
- Insurance Industry (ANZIIF) - _Desired_

**Experience**
- Experience in a similar role in General Insurance Claims, Customer Management and Quality Assurance / Audit
- _Mandatory_
- Technical and regulatory knowledge of insurance, reinsurance, or financial service sector, in particular General
- Insurance Claims
- _Mandatory _
- Understanding of Project Management and Business Analysis