Life Health Senior Claims Specialist

General Re Corporation, a subsidiary of Berkshire Hathaway Inc., is a holding company for global reinsurance and related operations, with more than 2,000 employees worldwide. It owns General Reinsurance Corporation and General Reinsurance AG, which conducts business as Gen Re.

Gen Re delivers reinsurance solutions to the Life/Health and Property/Casualty insurance industries. Represented in all major reinsurance markets through a network of 37 offices, we have earned superior financial strength ratings from each of the major rating agencies. We value diversity, equality and inclusion and promote a culture that supports professional and personal growth.

Your Role

Our Australian Life and Health Claims Team is seeking to appoint a suitably qualified Senior Claims Specialist to work in our Sydney office.

Your Key Responsibilities

• Assessing life claims through the analysis of financial, medical and occupational/functional evidence.
• Managing the performance of portfolios of reinsured claims through the provision of strategic claims management plans, guidance and coaching.
• Liaising with clients to develop processes to encourage early notification and intervention strategies to facilitate claims outcomes and control claim duration.
• Identifying claims that would be appropriate for rehabilitation or case management intervention from the Gen Re Case Management Service.
• Maintaining a strong client focus with emphasis on relationship management.
• Liaising with clients to understand their needs and identify and communicate opportunities where Gen Re can add value to their business.
• Participating in the delivery of training modules and presentations to facilitate continued professional development at an industry level.
• Undertaking portfolio analysis, identifying claims incidence and experience trends as well as formal audits and reviews of clients claims portfolios.
• Providing insights to your Gen Re colleagues and clients on current and emerging industry trends and claims best practice nationally and internationally.
• Promoting the company's services to industry participants.

In addition to the key accountabilities of a LH Senior Claims Specialist you will manage relationship and portfolio strategies of allocated clients and treaties.

Key responsibilities include:

• Maintain regular, targeted client engagement at appropriately management levels, facilitating alignment on complex disputed claims matters.
• Lead discussions with clients on complex, disputed and sensitive claims matters, claims risk considerations to achieve appropriate outcomes and resolve differing stakeholder perspectives.
• Proactively research and monitor current and emerging complaint impacting the Life & Health insurance industry.
• Collaborate across GRLA, regional segments, and global teams to translate these insights into practical applications, enhance internal practices, and effectively increase the awareness with clients in response to the evolving complaint landscape.
• Appropriately escalay and refer potential disputes within the claims process to ensure client concerns and complaints are managed promptly and in accordance with established internal service standards, regulatory requirements and the Global Authorities Framework.

In your area of expertise, you will:

• Liaise with the Gen Re Global, and Segment Departments on disputed claims and when appropriate Gen Re Legal, providing local market expertise and supporting internal stakeholders as required.
• Provide expert policy interpretation and coverage advice, including a specific focus on morbidity and mortality claims.
• Develop, implement and execute commutation strategies aligned with Gen Re's risk appetite.
• Represent GRLA in the Global & Segment Claims inforce management meetings ensuring insights, local regulatory requirements, Ombudsmen activity and LICOP nuances are at the forefront of discussion.
• Provide product-related advice as required, ensuring alignment with the claims controls framework.
• Contribute to industry thought leadership groups through delivering presentations and authoring blogs/articles within your area of expertise.

Your Profile

• Extensive experience providing technical claims leadership in complex, disputed, and high value life/health insurance claims environments.
• Demonstrated ability to influence and negotiate with senior stakeholders on complex and contentious claims matters.
• Expert knowledge of:
  • Insurance Contracts Act (1984)
  • Life Insurance Act (1995)
  • SIS Act (1993)
  • Life Insurance Code of Practice (LICOP)
  • Litigation processes and dispute resolution frameworks.
• Demonstrated ability to:
  • Interpret and apply legal principles to claims scenarios.
  • Develop strategies for high-risk and contentious claims.
  • Influence senior stakeholders and drive sound claims and risk management outcomes.
• Strong capability in:
  • Policy/Contract wording interpretation
  • Non-disclosure, misrepresentation and potential fraud assessment
  • Regulatory analysis and application.
• Highly developed communication skills, with the ability to convey complex legal concepts in a practical and accessible manner.
• Proven ability to operate as a subject matter expert in your field of expertise.
• Minimum of five years working as a dispute resolution specialist managing complex claims matters.
• Tertiary qualification in law.
• Demonstrated thought leadership in legal or claims-related topics.
• Experience contributing to regulatory or industry initiatives.

We offer a

• Hybrid working model (60/40 Office/Home)
• Highly professional and inclusive working environment that values excellence, integrity, personal responsibility, and diversity
• Excellent compensation and benefits
• Flat corporate structure with a strong team ethic
• Support for your personal and professional development

Contact

Human Resources

Our Address

General Reinsurance Life Australia Ltd.

Level 20
1 O'Connel Street
Sydney, NSW 2000 (Australia) ABN 73 002
166 869

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