Claims Management Consultant
3 months ago
**Location**: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 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.
- 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.
Who You Are**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
- 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 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
**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
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