Clinical Claims Assessor

4 weeks ago

Bristol, United Kingdom Irish Life Full time

**Location**:GB
- Bristol, GB**Company**:CLFIS Limited**Description:
- 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.- 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 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.

**What You'll Do**
- 1) 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
- 2) Analyse and appraise all information received and request gaps in medical and non-medical 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.

3) 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.

4) 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.

5) 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.

6) 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.

**Who You Are**
- Claim assessment_
- Some broader knowledge of insurance/protection products. Group and/or the health claims industry.
- Strong attention to detail so that all relevant facts are obtained to ensure fair and correct outcomes for every claim.
- Customer Service_
- 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.
- 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.
- Demonstrates professionalism through own behaviours and actions.
- Company strategy and core values_
- 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.
- Qualifications:_
- GR1 preferable
- Applicable licenses held preferable

**What you’ll like about working here**
- As a Canada Life UK colleague, you’ll receive a competitive salary and comprehensive reward package including income protection, private medical insurance and life assurance, along with a generous pension and bonus scheme. You’ll also receive the support you need with your personal and professional development.**Diversity and inclusion**
- Canada Life is committed to a diverse and inclusive workplace. Our role as an employer of cho

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