Complex Claims Examiner, A&H

Functional Responsibilities

• Managing key claims handling enquiry coverage determination, quantum analysis and legal liability assessment, where appropriate within authority limits and providing a consistently strong standard of customer service.

• Ensuring effective vendor and litigation management on Complex claims within a personal allocation

• Broader internal / external stakeholder communication where required

• Strive for continuous improvement on claim file handling with feedback and support through the Quality Assurance Review processes

• Contribute to maintenance of best practice procedures for A&H intermediate to high value Complex claims, consistent with global best practice

• Demonstrate a high standard of technical claims competence. Demonstrate a strong standard of competence in handling intermediate to advanced complex claims in A&H.

• Manage Third Party Administrators to ensure that they adhere to the claims handling guidelines and meet the agreed deliverables. This would include conducting audits and checks. Provide technical advice to Shared Services.

• Any other projects/tasks which may be assigned to you from time to time.

Accountabilities

• Timely, accurate and customer focused claim resolution, minimizing indemnity exposure and mitigating vendor and legal expense

• Effective communication of key advanced Complex claims and A&H portfolio messages to internal stakeholders.

• Financial control through consistent reserve and other financial transaction discipline

• Accurate and consistent policy interpretation