Assistant Claims Manager - Healthcare

Resumen:

Key Relationships: Claims staff, underwriters, insureds, brokers and service providers

Job Summary:

To proactively manage claims, primarily at the individual level while gaining experience at the portfolio level through observing and working with peers.

A key requirement of the role is to assist with a focus on medium sized Healthcare claims and to achieve high levels of satisfaction for the client and broker through high quality claims management, resolution, and excellent client service.

To work with underwriters and support brokers and clients. To support claims management to facilitate and foster a collaborative approach across the overall claims function to learn, share ideas and diverse perspectives, and work in a manner that best meets the challenges of our clients.

Key Responsibilities:

• Manage individual claims on a proactive basis from notification to closure, investing the necessary level of involvement required for each claim depending on the nature, category, maturity, type, and quantum of the claim.
• Focus primarily on the management of claims with an expected or actual value at or below $250,000 without Coverage Litigation or other significant flags.
• Adhere at all times to Beazley’s Claims Reserving Philosophy and Standards.
• Act at the direction of line management to develop, iterate, document, and execute claims strategies considering uncertainties, key decisions, potential outcomes, and estimated associated costs.
• Engage and liaise with line management as appropriate on specific claims where additional experience or knowledge may be beneficial or is required.
• Understand and implement Beazley’s Conduct Risk Policy.

Claims Portfolio Management

Work alongside and support Claims Managers in the management of the claims portfolio to optimise performance including the:

• Review of individual claims within the portfolio on a regular basis and ensuring reserves and records are maintained in a timely manner as required by Beazley’s claims controls and standards.
• Communication of any material claims to Reinsurance and Finance as set out by the applicable claim’s authority, claims protocols, and procedures.
• Working with Reinsurance to effect recoveries.

• Understand the overall strategic objectives and business plans of the Beazley claims function to the degree required to engage and liaise effectively with line management.

• Develop an understanding of marketing and underwriting strategies for the respective business area.
• Provide input to underwriters on review of potential or existing insured’s claims experience.
• Identify claims trends and developments and communicate their potential impact on the book.

• Operate within approved claims authorities at all times.
• Maintain a thorough knowledge of industry regulations and minimum standards.
• Ensure compliance with the regulations and Beazley’s claims control standards and protocols.

• Follow Beazley’s procedures for the selection and retention of 3rd-party professionals and manage these relationships to the benefit of Beazley.
• Conduct file reviews or audits, where required, and assist in the resolution of any issues identified.

• Work proactively to develop strong relations with key brokers and insureds.
• Promote the Beazley brand of excellence in client service professionalism.

• Ensure the management of claims conforms to the agreed standardised processes and use of share service functions as appropriate.
• Contribute to the commitment to, and active development of a continuous improvement culture within the overall claims function.

• Support senior Claims staff with any relevant tasks, projects, or initiatives to further develop skills and understanding of the broader organisation.
• Assist claims management and peers to develop, mentor, and empower junior staff.
• Serve as a positive role model for junior staff.

• Adhere to Beazley’s Conflicts of Interest policy, alert the appropriate person to any potential conflicts of interest, and take steps to resolve them promptly.
• Immediately advise your Head of or Group Head of Claims if any Beazley employee seeks to exert undue influence on you or any other team member to act improperly in the management, reserving, or settlement of any claim.

General

It is important that within all your interactions both internally and externally you adhere to Beazley’s core values - Being Bold, Striving for Better, and Doing the Right Thing – as they contribute to an internal environment of teamwork and promote a positive brand image and experience to our external customers. We also expect Beazley employees to:

• Comply with Beazley procedures, policies and regulations including the code of conduct, which incorporates the PRA and FCA Conduct.
• Undertake training on Beazley policies and procedures as delivered by your line manager, the Culture & People or assurance teams (compliance, risk, internal audit) either directly, via e-learning or the learning management system.
• Display business ethics that uphold the interests of all our customers.
• Ensure all interactions with customers are focused on delivering a fair outcome, including having the right products for their needs.
• Comply with any specific responsibilities necessary for your role as outlined by your line manager, the Culture & People or assurance teams (compliance, risk, internal audit) and ensure you keep up to date with developments in these areas. This may include, amongst others, Beazley’s underwriting control standards, Beazley’s claims control standards, other Beazley standards and customer relationship management.
• Adjuster license(s) may be required as part of your job responsibilities. If required, those licenses must be obtained within the first 90 days of your employment and in accordance with an individual licensing plan established by Beazley Compliance and your Manager.
• Carry out additional responsibilities as individually notified, either through your objectives or through the learning management system. These may include membership of any Beazley committees or working groups.

Personal Specification:

• Graduate Calibre

• Analytical skills: Problem solving (broad-based, analytical, conceptual, creativity), Analysis of financial statements, Financial assessments of claims, Data analysis, Decision-making
• Work management skills: Time and workload management, Self-starter, Planning, Achievement orientation, Productivity focus
• Interpersonal skills: Ability to influence others, Client and broker management skills, Purposeful communication, Flexibility, Active listening

• Past claims experience establishing liability and/or settlement resolutions.
• Functional knowledge & understanding: Claims management process, US/RoW Insurance market (general & focus group), US/RoW legal and regulatory environment, Alternative resolution approaches
• Healthcare claims handling experience required

• Outcome focused, self-motivated, flexible and enthusiastic
• Professional approach to successfully interact with senior management/ colleagues/ external suppliers
• Diplomatic

• Problem-solving
• Decisiveness
• Customer-focused
• Influencing others
• Attention to detail
• Team work
• Self-starter
• Analytical thinking
• Managing resources effectively
• Technical competency and expertise