Medical Claims Assessor
- Claims assessment. Gather appropriate evidence and medically assess information in order to accept or decline claims displaying logical reasoning. Consider the customers' expectation of the product so that claims decisions are fair and Legal & General does not suffer unnecessary financial loss or reputational loss.
- Manage Caseload. Manage claims from end to end, including all steps, taking responsibility for all customer communication, keeping the customer informed of progress and providing one point of contact so that customer satisfaction is maximised and expectations met.
- Work management practices. Process claims within claims guidelines so that quality and consistency across the area can be maintained, adhering to service standards and processes.
- Regulatory framework. Adhere to current financial, FOS, regulatory, legal and industry guidelines in processing and assessing claims, including DPA.
- Handle inbound and outbound Customer Contacts. Deal with all aspects of customer communication by taking and making calls, dealing with letters and emails, and using the most appropriate method of keeping customers informed eg: phone, letter, email, text, so that unnecessary incoming contact is minimised.
- Customer communication. Liaise with internal and external customers and third parties in a professional, friendly and efficient manner in order to obtain information. Ensure that customers' expectations of service are met whilst providing a positive impression of Legal and General. Utilise customer focused language.
- Appeals and complaints. Identify appeals and complaints and take ownership for trying to resolve them with urgency, so that complaints are acted upon quickly, root causes are escalated and customer satisfaction is achieved. Where it is not possible to resolve, pass complaint to authorised complaint handler without delay to ensure compliance with complaints response time limits.
- Supporting your team. Take responsibility for supporting your team by deputising as needed. Contribute to claims projects or other team or department initiatives by sharing knowledge and ideas and giving feedback to help develop the way others work and support the Claims area to ensure the area works as one team.
- The bigger picture. Gain understanding of industry and customer expectations of Claims Products and service. Use this knowledge to challenge existing work practices in an appropriate way by identifying and taking steps to improve service through liaising with team managers or other colleagues, and recording accurate.
- Insurance products and policy conditions experience
- Extensive understanding of different Claim events
- Those with Critical Illness, Terminal Illness or Death Claims Medical Assessing skills will have a definite advantage
- Awareness of Compliance regulations, and adherence to these
- Knowledge of legal aspects pertaining to claims, eg probate
- Extensive medical knowledge
- Ability to show empathy and sensitivity
- Good customer handling skills
- Good letter writing skills - especially when handling refuted claims
- Good writing skills - to summarise case notes clearly and succinctly
- Ability to look at a claim holistically - consider each case on it's own merits
- Ability to present a case perspective so that complex claims are referred and properly considered
- Ability to handle communication with 3rd parties such as reinsurers and medical providers
- Ability to handle difficult calls, when researching circumstances which may lead to a claim being refuted
Our view is that this role is suitable for agile working. This means we would consider a more flexible working arrangement, where your hours and work location are managed according to business, customer and personal needs. For this role, you would be based in Hove, but you could work in other Legal & General offices or at home, as necessary, provided this meets business needs. Details of agile working will be discussed during the interview process.