Job Description

The Claims Technical Specialist is responsible for providing technical advice, guidance and support to the Claims team on technical assessment and case management matters, to assist in reaching desired claims durations and outcomes in line with the terms and conditions of the policy.

Technical Support
Act as a subject matter expert, responding to Claims Consultant requests and enquiries and to authorise and review claims (and associated advantages payments)
Provide adverse decision review and sign off on assessment, which may require referral to internal Claims review body
Support Claims Consultants to use effective communication with customers, treating health practitioners and other stakeholders to drive the best service experience and appropriate claim outcomes for the customer
Support Client Managers and Team Managers in their reporting to funds and attendance at fund meetings/case conferences related to technical claim outcomes as required

Team Capability




Drive processes to support development of technical capability within claims and implement strategies lto develop technical skills in line with the TAL claims capability framework resulting in progression of delegated authorities in a timely manner
Coaching Claims Consultants in appropriately executing assessment practices ensuring the timely and quality management of claims. Including completing ‘above delegation’ and ‘within delegation’ reviews of individuals work and recording outcomes and prospects for development

Compliance
Contribute to the implementation of appropriate governance structures and quality assurance to successfully deliver business solutions.
Adherence to external regulations (eg. Privacy and Life Insurance Code of Practice) and all relevant legislation and industry guidelines

📌 Claims Technical Specialist Sydney
🏢 TAL
📍 Sydney