Senior Claims Operations Consultant
Avant MutualCouncil of the City of Sydney, New South Wales, Australia22 days ago
Job descriptionManage internal escalations and complaints, seeking expert input where required to ensure accurate and timely resolution. Oversee daily workflow allocation, ensuring tasks are distributed evenly to the CI team. Monitor urgent matters and the Notice of Intention (NOI) line to enable real-time issue resolution. Support the Senior Operations Manager in implementing and executing training and development plans. Provide continuous technical guidance, coaching, and constructive feedback to the Claims Intake (CI) team. Apply logic-driven process standards to determine objective indemnity decision outcomes. Make and document subjective decisions based on product and policy rules when objective outcomes are not possible. Manage declined and withdrawn indemnity decisions directly with members, ensuring clear communication and resolution. Promote a culture of learning and improvement by offering timely, respectful, and actionable feedback to Claims Intake and Claims Excellence Teams and Product. Provide dedicated contact point for all notifications (incident or claim) and support member to indemnity decision outcome, building rapport and representing Avant professionally. Review, evaluate and process member enquiries to the appropriate owner. Proactively manage end-to-end case management within Service Levels. Demonstrated technical expertise with deep understanding of claims process and indemnity assessment. Proven ability to coach effectively to process adherence, provide constructive, timely feedback and guidance that supports team learning, builds confidence, and enhances overall capability. Strong written and verbal communication, with ability to explain complex decisions clearly. Proven ability to work effectively with internal stakeholders and contribute to positive team culture. Strong analytical skills and sound judgement in resolving complex or escalated matters. Understanding of Medical Indemnity insurance. Understanding of Medico Legal claim types. General understanding of medical terminology preferable. Experience in coaching or team leadership preferred.
Location : Melbourne, Sydney, Brisbane (Hybrid) Type : 12 Month Fixed Term Contract
About the Role
This role is responsible for leading and executing the technical and quality capability of the Claims Intake (CI) team, ensuring that indemnity assessments and decision-making activities are accurate, consistent, and delivered within established service standards.
This includes :
- Managing and executing escalated decision activities in line with defined process standards, collaborating with key internal stakeholders, and using insights to uplift team knowledge and reduce future escalations.
- Providing expert support to the CI team in handling declined claims, responding to complex member enquiries, and managing complaints with professionalism and empathy.
- Acting as a subject matter expert in CI systems and processes.
- Assisting the Senior Manager, Claims Operations in daily workflow allocation, with a focus on timely handling of urgent and declined matters.
This role will also be expected to manage a small portfolio of indemnity assessments and decisions end-to-end.
Key Accountabilities
Operational Process Execution
Technical Support, Coaching, and Feedback
Service to Members
Key Capabilities Required (Qualifications, Experience And Skills)
Preferred Capabilities (Qualifications, Experience And Skills)
Equal Opportunity Employer
Avant supports doctors so they can serve Australia's diverse communities. Having diversity in our workforce brings valuable perspectives and strengthens our ability to support healthcare professionals.
We therefore welcome applications from people of all backgrounds, including Aboriginal and Torres Strait Islander peoples, people from culturally diverse communities, LGBTQIA+ individuals, people with disabilities, and those with caring responsibilities.
Our inclusive workplace is somewhere everyone can succeed.
Ready to join us?
If you're passionate about supporting Australia's healthcare professionals, we'd love to hear from you. If you require any adjustments during the recruitment process, please don't hesitate to contact us at careers@avant.org.au
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Senior Consultant • Council of the City of Sydney, New South Wales, Australia
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