Health Claims Assessor

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Job description

Who are Diligenta?

Our vision is to be acknowledged as Best in-class Platform based Life and Pensions Administration Service provider. Customer service is at the heart of everything we do and our aim is to transform our clients' operations. A business that has been described as 'home' by existing employees, we drive a culture that is founded on positive change and development.

Summary of the role

An exciting opportunity has arisen for a Claims Assessor to join the operations team at Diligenta. In this role, you will be responsible for assessing new claim notifications across a range of benefits, including Income Protection, Critical Illness, and Total Permanent Disability. Additionally, you will proactively review ongoing income protection and waiver claims.

You will deliver comprehensive and sensitive technical claims management, which involves gathering and assessing claims evidence and information, often through phone consultations, to support informed decision-making. Strong communication skills, particularly when interacting with vulnerable customers or managing difficult conversations, are essential.

You will ensure all claims are managed and assessed in accordance with our claims philosophy, within your delegated authority levels, and in line with industry guidelines and policy terms and conditions.

What you'll be doing

• Examine and evaluate insurance claims for accuracy, completeness, and eligibility based on policy terms and conditions.
• Make informed decisions regarding the approval or denial of claims based on gathered evidence and policy guidelines.
• Examine and evaluate insurance claims for accuracy, completeness, and eligibility based on policy terms and conditions.
• Investigate and verify the legitimacy of claims through document analysis, medical reports, and other relevant information.
• Liaise with medical professionals, legal advisors, and other third parties to obtain required documents and expert opinions.
• Maintain detailed and accurate records of all claim assessments, decisions, and communications.
• Ensure all claim files are up-to-date and comply with company policies and regulatory requirements.
• Offer exceptional customer service by addressing queries, concerns, and appeals from claimants promptly and professionally.
• Provide clear explanations regarding claim decisions and policy coverage.

What we're looking for

• Claims management experience within the following areas- Income protection, Waiver, Critical Illness, Terminal Illness, Serious ill Health & Ill Health Early Retirement and preferably CII Claims qualifications (but this isn't essential)
• Excellent judgement and decision making skills supported by strong analytical and critical thinking abilities to evaluate complex information.
• Ability to cope with varying workloads, pressure & priorities.
• Proficiency in analysing medical reports, financial documents, and other relevant data.
• High level of accuracy and thoroughness in reviewing claims and documentation.
• Ability to identify discrepancies and potential fraud.
• Ability to explain complex information clearly and concisely
• Strong commitment to providing exceptional customer service.
• The ability to communicate effectively and sensitively with vulnerable customers which may also necessitate some difficult conversations.

If you need any help or adjustments for any stage within the recruitment process due to health, disability, or any other reason, please let us know.

Ready to take the next step in your career? Apply today and become part of our innovative team!

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