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Claims Intake Consultant (12 Month Max Term Contract)

Claims Intake Consultant (12 Month Max Term Contract)

Avant mutuaSydney, NSW, AU
30+ days ago
Job description

About the Role

The role has responsibility for owning and executing Medical Indemnity claims assessment and decision activities. Following defined process standards and achieving target service level expectations, this role uses case management approach when supporting members through submitted notifications / claims to an indemnity decision.

This role forms a core focus within the end-to-end claims process for Medical Indemnity providing professional claims intake services for the individual, corporate, and group notifications / claims in line with relevant product and policy terms and conditions, subject to the Insurance Contracts Act (1984).

Key Accountabilities

Service to members

  • Provide members with dedicated contact point for all notifications (incident or claim) via member channel of choice to and support member with indemnity decision outcomes, building rapport, representing Avant professionally, leveraging our Service Principles throughout all interactions with members
  • Manage internal escalation / enquiry management with relevant stakeholders across Medical Indemnity (MI).
  • Review, evaluate and process member enquires to appropriate owner.
  • Proactively manage outcomes within defined Service Levels
  • Meet or exceed Customer Satisfaction Score (CSAT) for service delivered by the team member.

Operations Process Execution

  • Meet or exceed quality standards by maintaining acceptable levels of Critical Error Accuracy for Business, Compliance and Member metrics.
  • Deliver objective indemnity decision using the process standards.
  • When logic driven indemnity decision is not possible, make and document subjective decision on product & policy rules.
  • Manage, decline and withdrawal of indemnity decisions directly with member.
  • Manage internal escalations and seek expert opinions as required.

    • Avant Values and Personal Obligations

  • Maintain Work Health and Safety obligations and deliver on Values.
  • Deliver on expectations aligned to Operational Risk Management Framework, including incident logging / management, controls testing etc.
  • Maintain compliance with compulsory training and ensure keep up to date with external industry changes (e.g. : Aus Healthcare or Legal environment)

    • Key capabilities or experiences required to perform the role

  • Demonstrated ability to work as a collaborator with own and cross functional teams.
  • Demonstrated relationship management skills - i.e., rapport building with members and external, through empathy and resilience
  • Demonstrated Technical Expertise, to build knowledge across Medical Insurance Product and regulations i.e. : Aust Health care system.
  • Demonstrated ability to execute against standard processes, within agreed service levels and quality measures.
  • Risk / issue identification & escalation management.
  • General understanding of medical terminology preferable

    • At Avant, our people are the centre of everything we do for our members. We offer a range of benefits and opportunities to enable you to make a difference, learn, and grow in your career.

    Why work at Avant?

    At Avant, our people are the centre of everything we do for our members. We offer a range of benefits and opportunities to enable you to make a difference, learn, and grow in your career.

    We value our people by offering an inclusive workplace with a diverse range of benefits, flexible working options, career development, and internal mobility opportunities. Our flexible working arrangements are designed to enable genuine work-life balance.

    Your development is our priority and we have a variety of learning and development programs that will support you in your career.

    We offer support to our people via Employee Assistance Program (EAP), Health and Wellbeing programs, Tertiary Education Sponsorship and Support.

    We have a diverse and connected work environment where your contribution and ideas will be valued and respected and make a real difference to the lives of others.

    For further information, please contact our Careers team at careers@avant.org.au.

    Please note : Avant Mutual is a vaccinated employer. Prior to the commencement of your employment by Avant, you are required to be fully vaccinated against the Covid-19 virus or have a medical certificate stating that you cannot receive a Covid-19 vaccination for valid medical reasons.

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