PURPOSE OF THE ROLE

The Technical Claims Specialist is responsible for managing claim liability decisions for losses associated with our 24/7 Travel Assistance business, as well as oversight of other complex claims including pre-complaints, Customers experiencing vulnerability or Financial hardship.

The role enables extension of our care and medical advice service by undertaking proactive, rapid claims assessments to provide financial and proactive medical assistance to our domestic and international travellers or those expressing vulnerabilities.

Engagement with multiple stakeholders to manage a portfolio of Assistance and other complex claims cases, and levering off clinical experts, will guide liability decisions relating to specific Travel Policy Product Disclosure Statements. The ability to clearly articulate liability outcomes or requirements to make decisions will contribute to safeguarding and assisting our travellers when most vulnerable.

This role acts as a senior capability in the Travel Claims function, become go to people for guidance and advice for less experienced Team members, supporting coaching and development as well as Regulatory change and other change initiatives.

This role will include an on call component, to support emergency claims decisions required for Travellers on trip and Seeking assistance outside of AU business hours.

KEY RESPONSIBILITIES

Claims Handling

Timely autonomous decision making in active case management with delegation of authority limit. Time management and escalations must be in line with Standard Operating Procedures and Service Level Agreements.

Ensure financial decisions and directions are clear and documented on the case management system and in line with approved delegation of authority limits

Articulate thorough knowledge of Europ Assistance Travel Products using excellent written and verbal communications to internal and external stakeholders

Strong knowledge and compliance with regulatory and legislative requirements, insurance contracts act and internal procedures

Oversight of escalated/’pre-complaint’ claims

Oversight and Proactive handling of vulnerable customers (CEV) and those experiencing Financial Hardship.

Construct liability outcome letters to travellers to support customer experience and case progression

Attention to detail. Assess major loss and high-cost events to ensure all benefits and exclusions are considered when providing final liability decisions.

Maintain oversight of predicted versus actual case costs

Maintain a trusted relationship with the Underwriter and ensure internal financial approvals are documented on the case

Engages and provides claims direction at Daily Case Review meetings, or outside of this forum

Proactive engagement with peers and stakeholders, including Clinical SMEs, Claims, Complaints, and internal/external Underwriters, to prioritise traveller wellbeing and enhance customer experience

Stakeholder and Team Engagement

Maintenance of trusted relationships with Underwriters and reinsurer, facilitated through regular forums.

Engage and communicate regularly with internal stakeholders to manage blockers or risks that can impact service and care delivery to the traveller

Be a collaborative Partner with Assistance Leadership team to drive prompt claims decisions, customer centric outcomes and identify ways to enhance our services and value to the business.

Proactive engagement with peers and stakeholders, including Clinical SMEs, Claims, Complaints, and internal/external Underwriters, to prioritize traveller wellbeing and enhance customer experience.

Use Technical expertise to provide guidance and support to more junior Claims officers, providing authorisation within DALs on claims and coaching and feedback as called on.

Strategy and Continuous Improvement

Support the ‘you live, we care ethos’ by sharing ideas and insights for lifting the customer experience

Support integration of our customer journey enhancements by contributing to new initiatives for Travel Assistance.

Be a Technical expert contributing to and participating in complaints, product, Compliance and regulatory forums and supporting change and/or implementation of new initiatives or changes in regulatory requirements.

Engagement & Communication

Clear and concise direction on liability decisions

Available for on-call rotation to provide direction on claim liability outside business hours.

Communicate effectively across the team to ensure efficient and effective dissemination and communication to team members

WHS Responsibility

Ensure compliance with Workplace Health and Safety requirements across the team

Taking care of peers for sensitive case types, creating a safe space for debriefing and supporting psychological impacts on yourself and peers.

Risk & Compliance

Understand and comply with Europ Assistance Code of Conduct.

Ensure risks are identified and reported Risk Management Strategy and Compliance Management Framework

Compliant with General Insurance Code of Practice, Regulatory and Legislative requirements

Escalation of Media, Brand or reputational cases to Leadership Group

ROLE REQUIREMENTS

Essential

RG146 qualified

Minimum of 2-3 years’ experience in General Insurance demonstrating strong knowledge and understanding of liability decisions

Exceptional knowledge of General Insurance Code of Practice

Exceptional written, verbal and interpersonal communication skills

Autonomous in managing workload and decision making

Competent in computer/IT skills

Highly developed interpersonal, communication and negotiation skills

Desired

Qualification in General insurance or financial services

2-3 Years in a senior claims handling role in Travel insurance.

Strong understanding of Travel Assistance services.

Highly developed interpersonal, communication and negotiation skills