Claims Case Manager

at  MetLife

Location(s)

• Posting Location: Sydney, New South Wales

Country
Australia
Working Schedule
Full-Time
Work Arrangement
Hybrid
Posted Date
11-Jun-2024
Job ID
2862

SKILLS, COMPETENCIES & EXPERIENCE REQUIRED:

• Proven ability using the telephone professionally to speak to customers on a regular basis, using a range of questioning and summarizing skills, express empathy and build rapport
• Previous life claims experience
• Preferred experience in person centred communication and motivational interviewing
• Ability to deliver outstanding service levels on a daily basis
• Ability to work supportively within a team and assist team members with work as needed. To be a committed team player who openly communicates and shares knowledge
• Embraces change with a view to delivering excellent results
• A high level of attention to detail
• Weighing up multiple pieces of information and making a sound judgment.
• Excellent time management and ability to prioritise work at all times delivering quick outcomes with high accuracy
• Proven ability to work under pressure in an evolving environment
• Understand and weigh up motivation to return to work and biopsychosocial factors that affect disability
• Excellent computing skills and literacy and excellent file note keeping and data capture experience
• Strong financial calculation skills preferred
• Medical literacy preferred
• Passion for helping people and making a difference
• A caring approach and high personal integrity and honest
• Clear and concise communication skills. Strong listening skills essential and counselling skills preferred but not essential

QUALIFICATIONS/EXPERIENCE REQUIRED:

• Minimum 2-3 years’ experience in managing and assessing a claims portfolio end to end; including both Income Protection and TPD claims
• ANZIIF (or equivalent) or Tertiary qualifications highly desirable.
• Strong understanding and working knowledge of applicable regulatory, legislative and Compliance framework applicable such as the Life Insurance Code of Practice.

SUMMARY OF RESPONSIBILITIES:

To proactively manage and assess a portfolio of Salary Continuance (SCI) claims and TPD claims against the relevant policy/plan design and definitions in line with MetLife’s claim philosophy whilst ensuring service level agreements are met.

PRINCIPAL RESPONSIBILITIES:

• Ownership of portfolio and workflow associated with portfolio with the aim of ensuring we’re meeting customer requirements.
• Proactively manage claims end to end in line with the MetLife claims Philosophy
• Build rapport with customers over the phone by maintaining regular contact, identifying appropriate added support services and liaising with the Strategy & Recovery Team to support customers achieve their goals and return to health
• Manage all stakeholders expectations to support a seamless customer experience
• Assess claims against policy terms and explain complex decisions with logical and clear rationale and description of why evidence has been weighted over other evidence
• Instruct third parties to provide claim assessment support as appropriate to the claim situation and use claim providers in line with an appropriate cost benefit analysis
• Manage incoming work items in line with service level agreements, department objectives and practices
• Manage claims within appropriate risk and governance frameworks such as the Life Insurance Code of Practice and act appropriately as MetLife’s First Line of Defense for risk issues
• Ability to recognize, categorize and prioritize work requiring minimal intervention
• Ensure all written communication is timely, accurate and professional
• Create and release claim payments in line with delegated authority & calculate any CPI increases
• Contribute to the team through special projects when required
• Ability to adopt and embrace change and best of class: philosophy and championing change within the Claims and wider Operations team
• Work in a positive, optimistic and balanced way and support the team to complete the daily team workload. Support a positive culture in line with MetLife’s cultural values.