The Claims manager role is a key position within the Claims Division. The Claims Manager will support the business strategically and operationally in all Claims, Complaints and Risk Management processes in line with regulatory and company standards.
Primary Job Accountabilities/
- Oversight of the business’s Claims Assessment system and processes.
- Oversight of the business’s Complaints Claims Assessment system and processes.
- Accurately, independently and fairly assess and review claims and complaints and provide clear, concise and accurate instructions to those who fall under your direct supervision.
- Accurately, independently and fairly assess and review claims and complaints based on the T&C and provide clear, concise and accurate instructions to those who fall under your direct supervision.
- Review and audit the instructions carried out by individuals under your supervision ensuring communication is professional and that all progress and decisions to the customer is effectively and accurately recorded.
- Identify and escalate serious or urgent cases to the Manager Operations Continental Europe guidance concerning medical conditions and within the content of the insurance policy terms and conditions.
- Liaising with medical personnel, to discuss medical conditions and complex cases where required and report findings accurately.
- Ensure that Service Levels Agreements are met and report these to manager.
- Maintain a high level of Complaint-handling skills, in accordance with agreed service level agreements, contracts and against policy conditions. These skills include:
- Write letters to organizations such as Kifid and Ombudsman
- Write letters to customers or third parties related to complaint handling
Provide support in court cases/court and liaise with our external/internal legal departments
- Maintain a high level of Customer Service and administration skills at all times, which may include: Monitoring and checking claims, dealing with correspondence, Investigating and answering queries.
- Audit medical and lawyer’s invoices to support cost containment activity including the identification of potential cases of unnecessary or excessive medical services and court cases.
- Initiate and manage all referrals to ensure a response is received in a timely fashion.
- Accurately, independently and fairly assess and review Complaints directly related to claims.
- Conduct claims reviews on high value claims
- Assist and deal with ad-hoc projects.
- Contribute to the development of strong customer and client relationships, by understanding individual customer circumstances and requirements and delivering appropriate solutions.
- Maintain and display a thorough understanding of products, services and procedures. This to be reflected in all activities carried out
- Maintain the training of new staff and re-fresher training, when required.
- Maintain the department’s quality and customer service standards, responding promptly to service needs of customers. Be fully customer and client focused to ensure seamless handling of all work.
Contribute to overall team spirit and help create a positive working environment for all members of staff, whereby we are able to promote creativity and personal development, identify and contribute to your own personal development needs.
Basic Qualifications Required - Experience, Skills, and Knowledge
- Intermediate vocational education.
- English language - level B1 - verbal and in writing.
- Demonstrating practical skills with a customer contact basis.
- Intermediate level Microsoft Word, Microsoft Excel.
- Experience with claim handling and dealing with complaints, preferred
- Work experience in insurance industry, preferred
- Ability to multi-task, assess priorities and competently handle a variety of activities with a high-degree of accuracy in a fast-paced, deadline-driven environment.
- Ability to communicate effectively and professionally, strong verbal and written communication skills.
- Be able to work under pressure
- Sound judgement.
- Outstanding customer service and active listening skills.
- Ability to learn quickly and take on responsibility
- Flexible to adapt to changing priorities.
- Broad knowledge of companies’ products.
- Good knowledge of Microsoft Applications i.e. Microsoft Word, Microsoft Excel.
Environment/Physical Demands: This position requires incumbents to regularly sit at a desk and operate standard office equipment such as a computer and phone. Employee is occasionally required to stand and walk, lift, carry and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Must be able to talk and hear. Required to use hands to finger, handle, or feel objects, tools or controls. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.