Reporting to a Claims Manager, this role requires expert case management delivery of technical claim decisions and training of Junior Claims Assessors and Claims Administrators in the UCS Claims team across a sophisticated and diverse PanEurope corporate client base.
A primary challenge is to support the business in achieving aggressive growth targets by delivering expert claims management services that will be maintained throughout the lifetime of the products and the client relationship.
To manage a portfolio of claims by adopting best practise approach in order to meet competency levels and qualifications required to work in a busy claims function under MCC guidelines.
The role holder will medically assess all Group Risk product claims, typically - life, critical illness and income protection/ disability claims on Irish and international schemes/policies as they occur and at claim review stage, making recommendations and decisions within agreed Claim Approval Limits.
The role holder will have a primary coordinating role with Utmost Group companies, GEB, Reinsurers, Chief Medical Officer, IME consultants, Investigation services companies and with outsourced service providers to ensure prompt resolution of queries and claims.
Fitness & Probity
This role is a controlled function as defined by the Central Bank Reform Act 2010, Regulations (2011). Any appointment will be conditional upon satisfying the company that the jobholder meets the requirements as set out in the Fitness and Probity Standards issued by the Central Bank.
CF Status: CF6, SF2
Key Responsibilities
1. Customer Relationships & Complaint Resolution
To maintain effective broker relations, ensuring that prompt, accurate and comprehensive replies are provided to customers, dealing personally with complex issues and the effective resolution of any complaints.
• To maintain excellent working relationships with brokers and clients, inspiring their confidence in the reliability of services provided.
• To monitor the quality and content of customer communications.
• To ensure any complaints are fully investigated, dealt with in a timely manner, managed in accordance with our Complaints Process and any compensation/claim payments are logged accordingly.
• To be a recognised point of contact within Utmost and Utmost Group companies to resolve matters of mutual concern
• Be a key EB Claims contact and liaison on FSPO, Legal, Appeal, GDPR cases.
2. Maintain key relationships (Internal & External)
Builds and maintains effective working relationships with Head of Business lines, Heads of Support Functions, the senior staff in Utmost offices in multi Jurisdictions and all external service providers to cover claim management operational issues.
• Build and maintain positive and constructive working relationships with Generali Employee Benefits (GEB), SCOR, Utmost Group companies and their Office Managers to improve service delivery.
• Adherence to all operational procedures in the multi-jurisdictional offices. Identify areas for improving controls and act as a change agent to improve effectiveness.
• To ensure communications between operational staff and related Utmost offices is working effectively and without duplication of effort.
• To take a leading role in the Claims team weekly meeting.
3. Customer Service
• Act as a key technical contact for the UCS Claims team in relation to escalations, queries, complaints and reporting.
• Establish a service culture within the UCS department so that the operation meets or exceeds agreed KPI’s, SLA,s and other service standards
• Collate feedback from brokers and clients against agreed standards and report to Head of Claims and/or a Claims Manager in order to continuously enhance our service proposition.
• Ensure all internal and external service levels are adhered to.
4. Claims Administration & Management
• Deliver optimum efficiency and high quality claims service.
• Continuously aim to improve decision turnaround on pre-assessment claims.
• Ensure high quality claim decisions are made in a sensitive manner.
• Adopt an individual case management approach for all claims.
• Show rigid flexibility on all claims and client issues.
• Adhere to Reinsurer guidelines and Treaty rules.
• Ensure all claims are managed in line with our local & personal Claim Approval Limits (CALs).
• Liaise with colleagues, employers, third parties, CMO, physicians and rehab providers to ensure claimants successful and sustained reintegration to the workforce.
• Manage all complex claims appropriately and in conjunction with the Claims Managers.
• Provide continuous feedback to the claims Managers of any areas identified regarding policy terms and conditions on all products to ensure relevant and applicable to current markets.
• Provide continuous feedback to the Claims Managers of any areas identified regarding policy terms and conditions on all products to ensure relevant and applicable to current markets.
• Regularly review Claims Process Document and update with any process changes.
• Aim for parity on claim decisions –V- claims received in any given reporting period.
• Possess a high level of technical and medical expertise.
• Be resilient in facing day-to-day work challenges and focused on achieving desired results.
• Identify, consider and offer rehabilitation opportunities for claimants.
• Provide feedback to Head of Claims and Technical Claims Manager on positive and negative quality identified in order for Technical Claims Manager to grow Consultant availability nationwide paying specific focus to areas of medical speciality required to manage claims book effectively.
5. Claims Assessor & Administrator Training and Development
• Actively engage with the Claims Managers on technical training requirements and delivery for junior team members.
• Continuous technical development of junior team members.
• Up-skill and improve technical knowledge of junior assessors and administrators.
• Attend professional body seminars – Insurance Institute of Ireland, LIA, Health Insurance Society, LUCID and Reinsurer events.
• Case Management Best Practice Implementation.
• Attend and contribute to Group Round Table case study sessions.
• Attend Medical presentations in house within UPE & Utmost Group companies.
• Maintain appropriate process and procedures for delivery of service.
• Obtain CPD accreditation where possible for training delivered.
• Inform the Claims Managers where appropriate in order to maintain process documentation for all UCS Product lines, systems or regulatory changes and feedback from Audit and Risk functions.
• Ensure proficiency in the application of the procedures.
• Portray and instil risk adverse behaviours personally and across team.
6. Quality Control
• Adhere to process controls on all aspects of claims management to ensure high standards are set and maintained.
• Streamline the delivery of services to obtain maximum efficiency.
• Create template documentation in line with corporate communication standards.
• Maintain 4 eyes approach to all non-automated communications.
• Conduct regular checks on all output to ensure continued high standards are maintained and eliminate waste.
• Ensure 100% accuracy on delivery of UCS Claims benefit payrolls.
• Identify trends and propose solutions to increase accuracy and strengthen controls.
• Stakeholder in product development and change projects.
• Instil 100% accuracy philosophy on all aspects of claims management.
• Comply with all Fiscal, legal and regulatory obligations.
Key Tasks
Key Requirements
The role holder will:
1. Understand the balance between technical claim imperatives and service obligations.
2. Have a strong knowledge of Irish financial regulation and its application to life insurance companies.
3. Be a practical problem solver coupled with strong interpersonal skills.
4. Possess strong analytical and reasoning skills.
5. Oversee and implement proactive best practise case management on all claim product types.
6. Have experience with networking / liaising with a client and corporate broker base which is both diverse and multicultural.
7. Provide strong and consistent leadership to junior staff members.
8. Be a strong presenter and negotiator
9. Establish client confidence and deepen relations to retain and grow the business.
Knowledge – Experience or Qualifications
• QFA/APA in Life, Pensions & Regulations under LIA.
• Diploma in Life and Disability (DLDC) or Life and Pensions (APA) under the III.
• Experienced in Income Protection/Life claims management.
• Minimum of 3 years’ medical claims assessment.
• Expert knowledge of Group Risk Products.
• Third level education with a professional qualification in Claims Management industry related.
• Grandfathered Status under MCC
Skills
• Excellent communication, relationship management, analysis, report writing and interpersonal skills.
Behaviours
• Demonstrates a strong ability to drive excellence standard across team.
• Ability to work under pressure and to tight deadlines.
• Must have high professional standards and can demonstrate how to implement these across the claims team.
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