Internal Review Specialist

About the Role

The purpose of the role is to review client disputes and provide; fair, timely and evidenced-based recommendations that are in keeping with the Motor Accident Guidelines legislation.

Clear communication and informed decision-making are essential for optimal care and will be achieved by your critical reasoning skills, knowledge of evidence-based treatment and understanding of the reasonable and necessary criteria.

Benefits

• A corporate wellbeing program with subsidised gym membership, free flu vaccinations and health check programs
• icare day – access to an extra day's leave
• 17.5% annual leave loading
• Comprehensive learning and development support aligned to icare's Core Capabilities.
• Our People Awards - On-the-spot Recognition, Quarterly Values Awards & Our People Annual Awards
• Access to our Employee Assistance Program

Duties

• Conduct independent internal reviews of disputed CTP Care claims decisions under the Motor Accident Injuries Act 2017 (NSW) and Motor Accident Guidelines.
• Review claims, medical documentation and previous decisions to provide; fair, effective, timely and sustainable decisions relating to treatment and care.
• Apply critical reasoning skills and regulatory framework guidelines, including reasonable and necessary criteria to ensure a high degree of integrity in decision-making processes
• Foster and maintain working relationships with both internal and external stakeholders to facilitate the effective and efficient resolution of disputes.
• Display excellent written and verbal communication skills, providing clear rationale for decisions and open, pro-active communication with all stakeholders during internal review processes.
• Manage difficult conversations, showing empathy in managing both client and business concerns throughout dispute resolution processes.
• Liaise with internal and external legal stakeholders and the Personal Injury Commission in facilitating dispute processes.
• Apply a high level of attention to detail and analytical skills, to identify opportunities for continuous improvement to CTP Care's decision making, dispute handling processes and customer experience.
• Contribute to the evaluation and implementation of service delivery for clients, including participating in internal quality assurance and improvement, research and service development projects.

Skills & Expertise

• Sound understanding and experience in applying decision making criteria and writing reasons for decisions within regulatory framework guidelines.
• Previous experience applying a decision-making framework in a personal injury or health setting.
• Relevant tertiary qualifications in a health or disability discipline and/or strong practical experience in identifying, reviewing and coordinating services for people and families experiencing chronic injuries or disability.
• A sound understanding of the needs and perspectives of people with chronic injury within a legislated environment.
• Critical reasoning skills to ensure a high degree of integrity in the decision-making processes.
• Excellent communication skills (both written and verbal)- ability to build rapport and communicate complex information and create and nurture effective working relationships with all stakeholders.
• Ability to set clear expectations and engage in difficult conversations with clients and stakeholders in a clear and empathetic manner.
• Capability to work in a dynamic environment
• Qualifications in Insurance, Medical, Allied Health or related disciplines.
• Strong understanding of the Motor Accident Injuries Act 2017 (NSW) and Motor Accident Guidelines

Culture

We know our strength comes from the diversity of our people and would encourage people with different experiences and backgrounds to apply. We are committed to our people's development so the people of NSW can thrive.

About the Company

We care for the people of NSW, building confidence and trust so our communities can thrive. We make the complex simple, so our schemes deliver better outcomes for people and communities. Whether a person is severely injured in the workplace or on our roads, icare supports their long-term care needs to improve quality of life, including helping people return to work.

• For more information about icare visit our website

• icare operates a direct sourcing model so no agency introductions will be accepted

• We are a Circle Back Initiative Employer – we commit to respond to every applicant

• A talent pool may be created through this recruitment process.

Please note that you must be an Australian citizen, permanent resident of Australia, New Zealand citizen with a current New Zealand passport or have unrestricted working rights to apply for this role.