You'll work closely with various stakeholders to ensure claims are handled fairly, efficiently, and with care.
What To Expect
- Accurately assess, investigate, and manage long-term insurance claims, including disability and critical illness claims
- Prepare draft minutes for the Claims Management Committee (CMC), outlining assessment findings and reasoning
- Assist in organizing and preparing for weekly CMC meetings as required
- Liaise with brokers, employers, and members to gather necessary information and provide updates
- Actively present claims and participate in CMC meetings
- Follow up on action items from CMC meetings, liaising with reinsurers and other stakeholders as necessary to implement decisions and manage claims
- Coordinate with appropriately qualified independent service providers for external examinations and appointments
- Draft clear and concise letters communicating assessment decisions
- Ensure a strong understanding of the claims processing and payment procedures
- Lead and contribute to key projects within the claims team, including vocational rehabilitation and early intervention initiatives
- Respond to stakeholder queries efficiently and professionally within established turnaround times
- Provide support to service providers, offering clarification and assistance as needed
- Maintain timely, accurate, and complete data entries on all systems
- Adhere to established procedures and workflows, ensuring compliance with turnaround times
- Deliver high-quality service to both internal and external stakeholders, safeguarding their interests
- Ensure that claim assessments align with the company's values and standards of decision-making
- Foster a collaborative and supportive team environment
Qualifications and Experience
- Relevant Medical Qualification (e.g., Occupational Therapy, Physiotherapy, Nursing, etc.)
- Minimum of 2 years' experience in assessing Group Risk claims, with a strong background in disability claims. Exposure to lump sum claims such as Life, Capital Disability, and Critical Illness is an advantage
- Excellent interpersonal and communication skills, both verbal and written
- Strong understanding of Long-Term Insurance and Group Risk products
- Familiarity with Vocational Rehabilitation and the implementation of related programs
- Passion for improving processes, particularly those related to Vocational Rehabilitation
- Ability to work independently and as part of a collaborative team
- Strong time-management skills with the ability to meet deadlines and adhere to strict turnaround times
- Ability to thrive under pressure, maintaining both speed and accuracy
- Meticulous attention to detail and effective data management skills
- Strong problem-solving abilities with a pragmatic approach
- Highly self-motivated, proactive, and focused
- Commitment to maintaining client confidentiality
- Strong ethical standards and integrity in all actions
- Willingness to challenge the status quo and strive for excellence
- Ability to drive results and deliver on commitments
- Organized and detail-oriented with a passion for continuous learning and collaboration
