Clinical Claims Assessor

2 weeks ago

Bristol, United Kingdom Canada Life Group (UK) Ltd (The) Full time

Canada Life UK looks after the retirement, investment and protection needs of individuals, families and companies. We help to build better futures for our customers, our intermediaries and our employees by operating as a modern, agile and welcoming organisation.
Canada Life UK is transforming to create a more customer-focused business by providing our customers with expertise on financial and tax planning, offering home finance and annuities propositions, and providing collective fund solutions to third party customers.
To assess and accurately validate Clinical claims associated to all individual and corporate insurance products provided through the Protection business. Ensuring only valid claims are paid in accordance to the financial liability associated to the insured risk.
Within authority levels, independently set up claims to accurately reflect the financial liability.
Ensure escalation controls and checking procedures are followed for high benefit claims that exceed financial retention limits or personal authority levels.
Follow company procedures to accurately check eligibility of claimants to ensure only those where a financial liability exists progress to full claim assessment
Analyse and appraise all information received and request gaps in medical and non-medical information from appropriate sources.
Ensure accurate decisions are reached so that only valid claims are paid according to the definitions within the appropriate Policy Terms and Conditions.
For Clinical IP claims where recovery is expected - Conduct regular reviews of evidence to appraise claim validity and secure safe returns to work so that benefits are only paid for the period the claim is valid.
For Clinical IP claims were recovery is not expected (classified as X-files) - Check health and employment status in line with documented process and re-validate claims at appropriate times through to the Policy cease date.
Demonstrate an engaging and outstanding level of customer service to ensure strategic distribution partners and corporate clients, who continue to hold the policy after claim adjudication, remain with Canada Life for the long term.
Ensure all claim activity corresponds with Risk, Compliance and Legal guidelines and thorough audit trails reflect the highest levels of integrity required in a claims environment
Handle medical records and Personal Sensitive information in line with the company procedure.
Claim assessment
• Group and/or the health claims industry.
• Highly capable in following company procedure and applying policy terms correctly.
• Strong attention to detail so that all relevant facts are obtained to ensure fair and correct outcomes for every claim.
Demonstrates outstanding Customer Service skills to help maintain strong individual and corporate protection business sales.
• Uses all resources available to seek out the swiftest route to accurately verifying claims.
• Strong telephone and written skills that demonstrate the desire to go the extra mile to meet all customer and stakeholder requirements.
• Regulatory, Risk, Conduct and Compliance
• Highly attuned to the Risk Culture.
• High levels of awareness with regard handling personal sensitive information in a claim environment.
• We believe in recognising and rewarding our people, so we offer a competitive salary and benefits package that's regularly reviewed. As a Canada Life UK colleague, you'll receive a competitive salary and comprehensive reward package including a generous pension and bonus scheme, along with, income protection, private medical insurance and life assurance. We have a fantastic number of other benefits and support services as well as regular personal and professional development.
We care about doing the right thing for our people, customers and community and helping others to build better futures. We want colleagues to have rewarding careers with us so we invest in the development of our people, technology and workplaces. That's why we offer a range of training, flexible working and opportunities to grow and develop.
Diversity and inclusion
Building an inclusive workplace with a diverse workforce where everyone can feel they belong and achieve their potential regardless of gender, ethnicity or any other characteristic is a key commitment for us. Emerging talent is crucial to our growth and creating an environment that continues to inspire us all." We're happy to discuss flexible working arrangements, including part time, for any of our roles should this be a requirement for you.

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