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Health Claims Assessor
2 months ago
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 come available for a Claims Assessor to join the operations function at Diligenta.
You will play a key role in managing individual protection claims from initial notification through to final settlement on a daily basis within an agreed level of authority and within service standards.
You will be responsible for managing and accessing all claims in line with our claims philosophy 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
What you'll be doing
- 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.
What we're looking for
- Previous experience in claims assessment or a related field within the insurance industry.
- Experience in handling life insurance, health insurance, or pension claims is highly desirable.
- Strong analytical and critical thinking abilities to evaluate complex information and make sound decisions.
- Proficiency in analysing medical reports, financial documents, and other relevant data.
- High level of accuracy and thoroughness in reviewing claims and documentation.
- Ability to identify discrepancies and potential fraud.
- Excellent verbal and written communication skills for interacting with claimants, colleagues, and third parties.
- Ability to explain complex information clearly and concisely.
- Strong commitment to providing exceptional customer service.
- Empathy and patience in handling sensitive situations and distressed claimants.
If you need any help or adjustments for any stage within the recruitment process due to health, disability, or any other reason, please let us know.
Ready to take the next step in your career? Apply today and become part of our innovative team
