Reporting to the Claims Manager, the role requires the holder to provide full Claims administration assistance to the Claims teams via processing client communication, daily reporting, liaising with Medical Professionals whilst adhering to company policies and regulation. They will deliver on our promise to our customers by administering all group risk schemes to the highest standards whilst supporting customer retention strategies.

Primary objective is to support the business in achieving all KPIs set by delivering excellent Claims administration service throughout the lifetime of the products and the client relationship.
To manage all Claims administration tasks efficiently by applying best practise approach where possible in order to meet competency levels and qualifications required to work in a busy Group Risk function under MCC guidelines.

The role holder will complete administration on all Group Risk product claim applications, typically - life, critical illness and income protection/ disability on Irish and international schemes/policies as they occur, within agreed turnaround times.

The role holder will be required to liaise with Utmost Group companies, GEB, Reinsurers, Chief Medical Officer, IME Consultants, Tele-Interview Providers, Investigation services companies, Marsh, outsourced services and UPE Finance Dept & Payroll providers in order to complete payrolls as they arise – weekly/monthly and to ensure prompt and excellent service delivery on claims.

• To maintain effective broker relations, providing customers with prompt, accurate and comprehensive replies.
• Deliver high quality customer communications.
• Initiate day-to-day communication by telephone/email with Irish and International brokers, clients, members, claimants and medical professionals.
• Develop and maintain strong relationships with internal departments including Sales, Pricing, Finance, Claims, Underwriting, Compliance, Risk and Marketing;
• Active participation in team meetings, one to ones, client/ broker meetings.
  

Maintain key relationships (Internal & External)

• Builds and maintains effective working relationships with Utmost colleagues in multiple Jurisdictions, Morgan Ash, Advance Medical and all external service providers to cover claim management operational issues.
• Ensure adherence to all operational procedures to in the multi-jurisdictional offices.
• To ensure communications between operational staff and related Utmost offices is working effectively and without duplication of effort.
• Actively participate in the Claims team weekly meeting.
  

Customer Service

• Ensure all internal and external service levels are adhered to.

Claims Administration & Management

• Deliver optimum efficiency and high quality administration service at all times.
• Resolve client queries in a prompt & sensitive manner.
• Adhere to Reinsurer guidelines and Treaty rules.
• Be resilient in facing day-to-day work challenges and focused on achieving desired results. Maintain Claim database and Post Logs.
• Adherence to all procedures and Operational Risk
• Request medical information or arrange medical examinations as required
• Approve & pay invoices on a weekly basis.
• Provide relevant weekly and monthly information to Finance Dept.
• Run weekly payroll reports for claims expenses incurred in a timely manner.
• Continuously monitor Independent Consultants quality, fees, report turnarounds and performance.
• Provide feedback to Head of Claims and Technical Claims Manager on positive and negative quality identified.

Quality Control

• Adhere to process controls on all aspects of claims administration to ensure high standards are set and maintained.
• Streamline the delivery of administration function to obtain maximum efficiency.
• Ensure 100% accuracy on data input for delivery of benefit payrolls for UCS Claims Dept.
• Identify trends and propose solutions to increase accuracy and strengthen controls.
• Instil 100% accuracy philosophy on all aspects of claims administration.
• Comply with all Fiscal, legal and regulatory obligations e.g. GDPR, CPC

Knowledge – Experience or qualifications

• Previous experience in an office-based environment.
• Business Related Degree essential.

Skills

• Comfortable using Excel and Word.
• Strong organisational skills.
• Solid communication and relationship management skills.

Behaviours

• Ability to work toward tight deadline within a fast-paced environment.
• Open to continuous development regarding industry educational qualifications – DLDC Diploma (III) or QFA (LIA).