Health Claims Assessor

at  Diligenta

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.

Benefits

• 33 days including Bank Holidays
• Eligibility for an annual discretionary bonus scheme
• Personal and career development opportunities to progress your aspirations within the company as well as through our global parent company (Tata Consultancy Services)
• Access to Perks at Work (an online discounted shopping platform) saving you money on a wide range of goods and services, including your weekly food shop, holidays and electrical goods
• Cycle to Work Scheme & Interest free Season Ticket loans
• A companywide Wellbeing programme, including an Employee Assistance Programme and other benefits/resources to support your mental/physical and financial wellbeing
• A comprehensive set of Moments that Matter policies, such as Carer’s Leave, Foster Leave and Retirement Leave
• A contributory company pension scheme where we match your contributions up to 6%, Group Life Assurance (’Death in Service") & Group Income Protection
• Apply to find out about our other benefits

• 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.