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

- 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.
- Travellers' financial requests for assistance are responded to attentively and timely.
- Quality and Proactive Case co-ordination resulting in excellent customer experiences and health outcomes.
- Timely case actions support the 'you live, we care' ethos.
- 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.
- Meet & exceed KPIs for handling times and processes.
- Strict and evidenced adherence to all GICOP and ASIC & AFSL compliance and regulatory requirements.

STEAKHOLDER 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.
- Demonstrate professional and effective working relationships with internal and external stakeholders.
- Undertake timely escalation to internal and external stakeholders per Service Level Agreement and procedure.
- Consistent participation in Assistance/claims operating rhythms.
- Participation in Claims, Assistance, QA and Business forums to present and discuss case progression, trends or training and engagement opportunities.
- Participation in coaching forums.
- 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 & 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.
- Supporting continuous improvement initiatives for people, process, customer and system enhancements in line with the customer experience strategy.
- Consistently displaying a positive and constructive approach to change, leading by example.
- Active participation in projects and initiatives to implement product, regulatory, process and/or system changes.

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.
- Support the Assistance Leadership team to continually maintain and improve employee engagement.
- Create a culture of 'one team' across physical and remote working locations.
- Participation in Team Meeting and Virtual huddles to support operating rhythms across jurisdictions.

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.
- Adherence to Europ Assistance WHS requirements.

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 model positive risk behaviours and conduct in alignment with nib's risk culture.
- All Compliance training and/or reporting obligations completed in a timely manner.

ROLE REQUIRMENTS

- 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.
- Highly developed interpersonal, communication and negotiation skills.
- Qualification in General insurance or financial services
- 2-3 Years in a senior claims handling role in Travel insurance.
- Solid understanding of Travel Assistance services.
- Highly developed interpersonal, communication and negotiation skills.

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📌 Technical Claims Specialist (Queensland)
🏢 Europ Assistance Australia and New Zealand
📍 Queensland