Health Claims Examiner
5 days ago
We are seeking a skilled Health Claims Assessor to join our operations team at Diligenta. As a Health Claims Assessor, you will be responsible for assessing new claim notifications across a range of benefits, including Income Protection, Critical Illness, and Total Permanent Disability.
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.
- Claims management experience within the following areas- Income protection, Waiver, Critical Illness, Terminal Illness, Serious ill Health & Ill Health Early Retirement and preferably CII Claims qualifications (but this isn't essential)
- Excellent judgement and decision making skills supported by strong analytical and critical thinking abilities to evaluate complex information.
- Ability to cope with varying workloads, pressure & priorities.
- 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.
- Ability to explain complex information clearly and concisely
- Strong commitment to providing exceptional customer service.
- The ability to communicate effectively and sensitively with vulnerable customers which may also necessitate some difficult conversations.
If you need any help or adjustments for any stage within the recruitment process due to health, disability, or any other reason, please let us know.
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