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Claims Management Specialist
2 months ago
We are seeking a highly skilled Claims Management Specialist to join our team at Canada Life Group (UK) Ltd (The). As a Claims Management Specialist, you will be responsible for assessing and validating health claims associated with individual and corporate insurance products.
Key Responsibilities- Independently set up claims to accurately reflect the financial liability, within authority levels.
- Ensure escalation controls and checking procedures are followed for high benefit claims that exceed financial retention limits or personal authority levels.
- Analyse and appraise information received, including complex, multi-layered claims with objective and subjective, medical and non-medical information.
- Communicate complex health claim decisions, including those with mixed medical evidence, to claimants in a clear and empathetic manner.
- Conduct regular reviews of evidence to appraise claim validity and secure safe returns to work, ensuring benefits are only paid for the period the claim is valid.
- Investigate prolonged absences beyond expected recovery timescales, identifying causes and implementing appropriate action plans.
- Demonstrate an engaging and outstanding level of customer service to ensure strategic distribution partners and corporate clients remain with Canada Life.
- 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, maintaining thorough audit trails.
- Knowledge of insurance/protection products, group, and/or the health claims industry.
- High degree of medical knowledge to establish validity of complex claims with mixed evidence.
- Ability to challenge information with skill, care, and appropriate conduct to ensure only valid claims are paid.
- Highly capable in following company procedure and applying policy terms correctly.
- Strong attention to detail to ensure fair and correct outcomes for every claim.
We offer a competitive salary and benefits package, including a generous pension and bonus scheme, income protection, private medical insurance, and life assurance. Our culture is unique and incredibly important to us, with a focus on doing the right thing for our people, customers, and community.
