Claims Specialist

1 week ago

Melbourne, Victoria, Australia Chandler Macleod Full time

This role will report to the
**Manager, Claims Support Services** who is responsible for assisting the Senior Manager - Insurance Services, in the overall management of the insurance and claims function of the Fund. Working as a member of the team, this role is responsible for the handling of Death, Total and Permanent Disability (TPD), Terminal Illness (TI), Permanent Incapacity (PI), Terminal Medical Condition of Release (TMCR) enquiries. The role will also assist claimants/TPA's with their understanding of the claims process, set the expectation of the process and service they should receive; manage the claim and be an escalation point where their claim does not go as planned or they need further assistance and to restore the claim onto an appropriate course.

**Accountabilities**:

- Central point of contact to assist the organizations' s Coordinators, Front Counter, Advice and Complaints team and other member facing teams with their enquiries
- Handle enquiries end to end, within service standards, including any follow up with Administrator/Insurer and provide regular progress updates until resolved
- Manage claim escalations, including follow up with Administrator/Insurer and provide regular updates to the Member, until resolved
- Resolve enquiries within the organization's operational processes, risk appetite, SIS/ATO regulations, Claims Handling and service standards
- Support Insurance Operations brand, by proactively interacting with Workplace Services, Advice and Complaints team
- Maintain detailed and quality claims documentation and interactions on workflow management system
- Maintain high standard of Quality Assurance results to demonstrate risk, processes, regulatory obligations, and compliance measures maintained
- Identify, prepare material, and facilitate focus sessions to assist Workplace Services in their interactions with members
- Attend Workplace Services meeting as required
- Participate in regulatory change and process improvement projects, as directed by the Insurance Leadership team
- Drive a culture of service excellence which focuses on positive claims experience
- Foster positive relationships with external stakeholders, Administrator, and Insurer
- This role may be required to undertake various other related tasks and/or projects as directed by the Manager, Claims Support Services from time to time.

**Key Selection Criteria**:

- Detailed understanding of superannuation regulators and the requirements of organizations complying to Superannuation Industry (Supervision) Act 1994 (Cth) (the 'SIS' Act)
- Problem solving capabilities to improve member experience
- Well-developed written and oral communication skills, including strong analytical skills
- Excellent attention to detail
- Demonstrated ability to build and maintain relationships with a variety of stakeholders
- Strong organizational skills including the ability to work under pressure and meet critical deadlines
- Ability to work independently and cooperatively and as a member of a team
- Advanced working knowledge of MS Word, MS Excel, Outlook
- Tertiary qualification in a business-related discipline would be an advantage.

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