Health Claims Examiner

2 months ago


Telford, Telford and Wrekin, United Kingdom Diligenta Full time

About Diligenta

Diligenta is a leading provider of life and pensions administration services, committed to delivering exceptional customer experiences and transforming client operations.

Job Summary

We are seeking a skilled Claims Assessor to join our operations team, responsible for managing individual protection claims from initial notification to final settlement.

Key Responsibilities

  • Examine and evaluate insurance claims for accuracy, completeness, and eligibility based on policy terms and conditions.
  • Make informed decisions regarding the approval or denial of claims based on gathered evidence and policy guidelines.
  • Investigate and verify the legitimacy of claims through document analysis, medical reports, and other relevant information.
  • Liaise with medical professionals, legal advisors, and other third parties to obtain required documents and expert opinions.
  • Maintain detailed and accurate records of all claim assessments, decisions, and communications.
  • Ensure all claim files are up-to-date and comply with company policies and regulatory requirements.
  • Offer exceptional customer service by addressing queries, concerns, and appeals from claimants promptly and professionally.

Requirements

  • Previous experience in claims assessment or a related field within the insurance industry.
  • Experience in handling life insurance, health insurance, or pension claims is highly desirable.
  • Strong analytical and critical thinking abilities to evaluate complex information and make sound decisions.
  • Proficiency in analysing medical reports, financial documents, and other relevant data.
  • High level of accuracy and thoroughness in reviewing claims and documentation.
  • Ability to identify discrepancies and potential fraud.
  • Excellent verbal and written communication skills for interacting with claimants, colleagues, and third parties.
  • Ability to explain complex information clearly and concisely.
  • Strong commitment to providing exceptional customer service.
  • Empathy and patience in handling sensitive situations and distressed claimants.


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