The role has responsibility for owning and executing Medical Indemnity claims assessment and decision activities. Following defined process standards and achieving target service level expectations, this role uses case management approach when supporting members through submitted notifications / claims to an indemnity decision.
This role forms a core focus within the end-to-end claims process for Medical Indemnity providing professional claims intake services for the individual, corporate, and group notifications / claims in line with relevant product and policy terms and conditions, subject to the Insurance Contracts Act (1984).
Key Accountabilities
Service to members.
- Provide members with dedicated contact point for all notifications (incident or claim) via member channel of choice to and support member with indemnity decision outcomes, building rapport, representing Avant professionally, leveraging our Service Principles throughout all interactions with members
- Manage internal escalation/enquiry management with relevant stakeholders across Medical Indemnity (MI).
- Review, evaluate and process member enquires to appropriate owner.
- Proactively manage outcomes within defined Service Levels
- Meet or exceed Customer Satisfaction Score (CSAT) for service delivered by the team member.
- Meet or exceed quality standards by maintaining acceptable levels of Critical Error Accuracy for Business, Compliance and Member metrics.
- Deliver objective indemnity decision using the process standards.
- When logic driven indemnity decision is not possible, make and document subjective decision on product & policy rules.
- Manage, decline and withdrawal of indemnity decisions directly with member.
- Manage internal escalations and seek expert opinions as required.
- Maintain Work Health and Safety obligations and deliver on Values.
- Deliver on expectations aligned to Operational Risk Management Framework, including incident logging/management, controls testing etc.
- Maintain compliance with compulsory training and ensure keep up to date with external industry changes (e.g.: Aus Healthcare or Legal environment)
- Demonstrated ability to work as a collaborator with own and cross functional teams.
- Demonstrated relationship management skills - i.e., rapport building with members and external, through empathy and resilience
- Demonstrated Technical Expertise, to build knowledge across Medical Insurance Product and regulations i.e.: Aust Health care system.
- Demonstrated ability to execute against standard processes, within agreed service levels and quality measures.
- Risk / issue identification & escalation management.
- General understanding of medical terminology preferable
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