Claims Management Consultant
1 month ago
Part of our parent company Great-West Lifeco, Canada Life UK has operated in the United Kingdom since 1903. We have hundreds of respected and supported employees committed to doing the right thing for our customers and colleagues.
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.
Job Summary
To assess and accurately validate all types of Health claims associated to 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.
What You'll Do
- 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.
- For all Health claims including complex, multi layered claims which include objective and subjective, medical and non-medical information, analyse and appraise information received and request gaps in information from appropriate sources.
- Ensure inconsistent information is clarified through effective research and questioning techniques.
- Ensure accurate decisions are reached so that only valid claims are paid according to the definitions within the appropriate Policy Terms and Conditions.
- Communicate complex health claim decisions, including those with mixed medical evidence with empathy and in plain English to ensure claimants understand reasons for claim outcome.
- For Complex IP Health 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.
- Where prolonged absence is evident, beyond the expected recovery timescales, research and investigate to identify causes and implement appropriate actions plans.
- Ranging from complex rehabilitation plans to alternative outcomes which may be a fair alternative for claimants such as Commutation or Settlement.
- 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.
- Recognise claimant vulnerabilities and ensure customer service skills reflect a considered course of action.
- 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
- Knowledge of insurance/protection products. Group and/or the health claims industry.
- High degree of medical knowledge to establish validity of complex claims that can contain mixed evidence of validity that can be both medical and non-medical in nature.
- Ability to challenge information with skill, care and Knowledge of insurance/protection products. Group and/or the health claims industry.
- High degree of medical knowledge to establish validity of complex claims that can contain mixed evidence of validity that can be both medical and non-medical in nature.
- Ability to challenge information with skill, care and appropriate conduct to ensure only valid claims are paid. This can mean challenging GPs or other medical professionals where inconsistent evidence has been provided
- 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 manage complex claim scenarios where disputes are more likely to arise than claims of a clinical type.
- 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.
- Strives to improve processes for the benefit of customers, claimants and Canada Life
- Highly attuned to the Risk Culture.
- High levels of awareness with regard handling personal sensitive information in a claim environment.
- Demonstrates professionalism through own behaviours and actions.
- Shares knowledge with team colleagues and demonstrates willingness to support broader business and strategic goals.
- Flexibility evident to supports other teams depending on service standards and volumes of incoming work by team
- Willing to cross skill to ensure consistent service standards can be maintained across the business function
- Responds positively to change through constructive commentary.
- GR1 preferable
- Applicable licenses held preferable
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.
How we work at Canada Life
Our culture is unique and incredibly important to us. We care about doing the right thing for our people, customers and community and helping others to build better futures. Our blueprint behaviours shape and influence how we work, and are central to the relationships we have with others. Every day we are encouraged to be more curious, own the outcome, face into things together and find a way forward.
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. We are proud of the progress we're making in DEI, and we continue for it to be a significant focus.
"At Canada Life we believe in the power of great people from different backgrounds, experiences and perspectives coming together to build better futures. Emerging talent is crucial to our growth and creating an environment that continues to inspire us all." Nick Harding, Chief People Officer, Canada Life UK
We appreciate that everyone has different work and life responsibilities. We're happy to discuss flexible working arrangements, including part time, for any of our roles should this be a requirement for.
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