Claims Technical Specialist

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.A key focus of the role is to optimise assessment quality within the Income Protection, Life, Trauma and TPD portfolios and support Claims Managers to build their capability in line with the TAL claims capability and delegated authority frameworks. Contribute towards a culture of process improvement. Along with the Team Manager, ensure that change initiatives are embedded and that best practices are adopted, while ensuring a best practice approach to claims handlingContribute to department and company projects as required.Maintain current knowledge of life insurance guidelines, processes and policy changes.Ensure claims handling and service approach reflects industry best practice and TAL processes and policies.Other ad-hoc duties as requiredTechnical SupportAct as a subject matter expert, responding to Claims Consultant requests and enquiries and to authorise and review claims (and associated benefits payments)Provide adverse decision review and sign off on assessment, which may require referral to internal Claims review bodySupport 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 customerSupport Client Managers and Team Managers in their reporting to funds and attendance at fund meetings/case conferences related to technical claim outcomes as requiredDevelopment/ enhancement of claims handling procedures and guidelines as required. Assist with embedmentReview, advise and sign off (within delegation) on policy T&Cs within internal forums, communicating the outcome of approved policy T&Cs within team to ensure understanding/applicationTeam CapabilityDrive 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 mannerCoaching 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 opportunities for development Provide insights into Case Manager technical capabilities for the purpose of performance management and support the Team Manager in development planning for individuals to uplift their capability in line with TAL’s capability framework.Deliver training as requiredComplianceContribute to the implementation of appropriate governance structures and quality assurance to successfully deliver business solutions.Ensure compliance with TAL policies, procedures and guidelines procedures, ensuring claims management is in accordance with the TAL claims philosophy Adherence to external regulations (eg. Privacy and Life Insurance Code of Practice) and all relevant legislation and industry guidelinesEnsure 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