MetLife

Summary of Responsibilities: To proactively manage and assess a portfolio of TPD claims and Income Protection (IP) claims against the relevant policy/plan design and definitions, MetLife's claim philosophy whilst ensuring service level agreements are met.

Principal Responsibilities: 

• Proactively manage a portfolio of high complexity disability claims in line with the MetLife claims Philosophy 
• Provide proactive customer support by keeping people making a claim updated on the progress of the claim assessment. Manage all stakeholders expectations to support a seamless customer experience 
• Build rapport with people on claim over the phone, establishing disability level (and for IP: return to work motivation and return to work plan) and achieve appropriate NPS customer engagement score 
• Assess claims against policy contracts and explain complex decision in writing over the phone with logical and clear rationale and description of why evidence has been weighted over other evidence 
• Instruct third parties to provide claim assessment support as appropriate to the claim situation and use claim providers in line with an appropriate cost benefit analysis 
• Manage incoming work items in line with service level agreements, department objectives and practices 
• Manage claims within appropriate risk and governance frameworks such as the Life Insurance Code of Practice and act appropriately as MetLife's First Line of Defense for risk issues 
• Ability to recognize, categorize and prioritize work requiring minimal intervention 
• Ensure all written communication is timely, accurate and professional
• Request appropriate evidence of income to calculate usual earnings for employed and self-employed people. Calculate benefit payable against the policy calculation method. 
• Create and release claim payments in line with delegated authority & calculate any CPI increases
• Contribute to the team through special projects when required 
• Ability to adopt and embrace change and best of class: philosophy and championing change within the Claims and wider Operations team
• Work in a positive, optimistic and balanced way and support the team to complete the daily team workload. 
• Support a positive culture in line with MetLife's cultural values. 
• Promotion of MetLife's insurance operations internally and externally 

Skills, Competencies & Experience Required: 

• Minimum of 12 months of relevant experience in claims assessment, within the Life Insurance Industry 
• Preferred allied health background (but not necessary)
• Ability to efficiently manage a portfolio of claims holistically to achieve sustainable, timely outcomes and within SLAs and financial services law claims handling provisions and Life Code of Practice 
• Excellent proven ability in using the telephone professionally to speak to customers on a regular basis, using a range of motivational questioning and express empathy and build rapport 
• Preparing all customer communication, including complex information and adverse decision advice 
• Ability to review insurance policy information and apply these appropriately to manage claims in line with terms and conditions of the same
• Ability to review and complete complex financial calculations 
• Ability to deliver outstanding service levels on a daily basis 
• Ability to work supportively within a team and assist team members with work as needed. To be a committed team player who openly communicates and shares knowledge 
• A high level of attention to detail 
• Excellent time management and ability to prioritise work at all times delivering quick outcomes with high accuracy 
• Proven ability to work under pressure in an evolving environment 
• Understand and weigh up motivation to return to work and biopsychosocial factors that affect disability 
• An understanding of life insurance policy conditions and contracts 
• Excellent computing skills and literacy and excellent file note keeping and data capture experience 
• Clear and concise communication skills
  
  

Qualification Required: 

• ANZIIF (or equivalent) or Tertiary qualifications highly desirable. 
• Strong understanding and working knowledge of applicable regulatory, legislative and Compliance framework applicable such as the Life Insurance Code of Practice. 

Personal Attributes: 

Positive, optimistic, warm, compassionate, confident, patient, calm, fair, honest, respectful of others, has integrity, open, resilient, strong talker and listener, hardworking, team player, leads by example, encourager, self-motivated, supports change in a positive way, owns their culture. Takes ownership and where needed, leadership