About This Role

• Ability to make claims/medical decisions taken within approved authority limits plus known triggers to escalate and refer decisions outside of agreed authority limits.
• To interpret policy terms and conditions, medical evidence and financial accounts in order to reach a decision on the validity of a claim.
• Provide thorough and robust justifications of decisions and refer cases to third parties including, CMO, reassurers and client company contacts in an accurate and clear manner.
• To communicate well both verbally and in writing to give clear instruction, adhere to Consumer Duty, manage the claimant’s expectations and portray high standards of claim assessment.
• To support our pro-active approach to claim management by use of the telephone wherever appropriate to establish the circumstances of a claim, clarify information, triage and manage the expectations of the claimant.
• To demonstrate good questioning skills in both written and oral communication in order to achieve the desired outcome effectively.
• Achieve service level agreements.
• Demonstrate a flexible and co-operative approach towards changing business needs.
• Contribute to a positive and supportive team culture.
• Work to increase own skills and knowledge.
• Work with key customers and distributors (client companies, claimant’s/customers and reassures customer) to provide first class customer relations.
• Ensure internal and external audits results are of an acceptable standard

• Previous experience in 1 or more of the following Waiver of Premium, Income Protection, Critical Illness and Life Time Care benefit (this is desired, not essential as training will be given)
• Good knowledge of products, services and systems.
• Good knowledge of relevant legislation, FCA principles, in particular, Treating Customers Fairly.
• Passionate about delivering excellent customer service and claims management and committed to treating customers fairly.
• Strong interpersonal, communication, and telephone skills, with the ability to triage claims, identify red flags, and manage customer expectations professionally.
• Excellent organisational and planning skills
• Collaborative team player, working effectively with Claims Assessors, Underwriters, and Claims Administrators.
• Sound judgement, strong decision-making, and a thorough, detail-oriented approach to claims assessment.

The hiring manager to contact is: Sharon Rennie & Malcolm Isdale Email: Sharon.Rennie@diligenta.co.uk & Malcolm.Isdale@diligenta.co.uk

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