This role is accountable for handling the process aspects of claims assessing required by Claims Consultants to assess claims. The Claims Assistant will also assess low complexity claims as well as assessing and initiating appropriate support options tailored to the customer’s needs where appropriate.
This role is integral to meeting the quality and service standards which ensure the functions are meeting TAL’s Customer and Claims requirements.
- Ensure compliance with TAL policies, procedures and guidelines procedures, ensuring claims management is in accordance with the TAL claims philosophy
- Adhere to external regulations (e.g., Privacy and Life Insurance Code of Practice) and all relevant legislation and industry guidelines
- Ensure all interactions with Customers, Advisers and other internal and external stakeholders adhere to TAL’s
- Customer Service Culture through the provision of high-quality, accurate and compliant work
- Liaise closely across the TAL Claims and other relevant internal departments to provide support in project work (including system and user acceptance testing and procedural reviews)
- Contribute towards a culture of process improvement
- Contribute to department and company projects as required
- Other ad-hoc duties as required.
Undertake customer service and administration in support of the Claims function, including but not limited to:
- Preparing initial claims for assessment
- Labelling Documents in claims systems
- Monitoring team workflows and taking actions to ensure workflow prioritisation and portfolio management
- Co-ordinating referrals including Medebridge, CDAP, Health Team, Reinsurance
- Scheduling and co-ordinating appointments
- Data entry
- Oversight of claims closures
- Placing LTC checklists into claims
- Oversight of invoicing
- Summarising information from customers e.g., medical reports, clinical notes, rehab updates and progress claim forms
- Answering simple queries from customers e.g., Request for Payment Summaries or payment due dates
- Logging Complaints and Incidents on behalf of consultants
- Holiday/ leave and coverage
- Management of Low Complexity Claims portfolio
- New consultant process coaching
- Draft simple letters to customers – e.g., 5.5 /Payment letters Minimum 1-2 years in a customer service-based role
- Excellent problem-solving skills
- Ability to build rapport over the phone and demonstrate empathy with customers during difficult times
- Outstanding relationship management and negotiation skills
- Meticulous attention to detail
- Understanding of medical terminology (desirable)
