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I am partnered with a growing and friendly financial services organisation, who are looking to identify an Income Protection Claims Assesor. It is crucial that the successful individual does have a experience in Income Protection Claims Assessing and is looking to continue in that field.
PURPOSE OF THE POSITION
- To manage claims across all IP products by balancing the need for making sound commercial decisions with treating customers so that our brand reputation is enhanced with our customers
- To manage risk within the IP Claims team and the broader company by ensuring regulatory compliance and by offering the best service which will generate and retain business
- To reinforce TCF and the company Brand by ensuring KPI and SLA performance is achieved and maintained, and that team members live the values of our vision and purpose, to act as a role model.
KEY RESPONSIBILITIES
- To assess and authorise IP claims in an accurate and timely manner in accordance with policy terms and conditions, claims procedures and claim’s philosophy. Developing core capability to assess, approve and process IP Claims
- To review ongoing claims with appropriate referrals and make recommendations for management plans
- To liaise effectively with medical professionals, intermediaries, and internal and external customers
- To provide support and guidance to customers in relation to claims; both the large majority that are successful and in the small minority where it is necessary to decline the claim
- To source and arrange independent assessments, treatments, home visits and private investigators in conjunction with current claims management policy
- To have regular contact with policyholders via the Health Claims Advisory Service to build relationships and assist with a smooth and uneventful return to work
- To write confidential correspondence to medical professionals, financial advisors, policyholders, reassurers, employers, and suppliers where appropriate, ensuring that urgent issues are brought to the attention of the Manager
- To research and keep up to date with developments in the industry and initiatives in claims management
- To assist with the development of the claims philosophy, service, systems, and procedures
- To understand the relevant financial regulators Principle based Regulation and to report any failures/potential risks to the manager immediately
Financial Crime
- Ensure compliance with regulation and legislation surrounding fraud by reportingsuspicion of fraud to your Manager and / or Compliance, including, but not limited to, contrived claims (working and claiming), induced claims, application fraud and internal fraud.
- Ensure compliance with regulation and legislation surrounding Anti-Money Laundering (AML) by submitting (role dependant) a Suspicious Transaction Report (STR) when a financial transaction takes place because of financial crime, including fraud. This should include payments made to claimants in cases where we have established that fraud has been committed.
- Ensure compliance with the Insurance Fraud Register (IFR) process by reporting cases of established fraud to (appropriate IP Claims Employee / Compliance) who will then report it to Compliance / the IFR, if sufficient evidence exists and is available to support such a report.
- Ensure compliance with the Bribery Act 2010 by reporting suspicion of bribery and corruption, which in some cases, depending on the circumstances, may include the giving of, or receiving of gifts and hospitality.
- Ensure the accurate collation and recording of evidence related to any instances of financial crime.
- Further information regarding compliance with The business's financial crime controls can be found in our Financial Crime Policy, page 155 in our Policy Handbook
OTHER RESPONSIBILITIES
- Adhere to the Financial Conduct Authority Individual Conduct Rules, and The business's Expectations - please refer to the relevant appendices
EXPERIENCE AND QUALIFICATIONS
- Claim business processes including policy cover, financial/medical underwriting criteria and conflict handling
- Insurance industry knowledge
- Understanding of the financial advisor market and how it interacts with the company’s products
- Sound IT skills
- Must have the right to work in the UK
PERSON PROFILE
- Excellent customer service skills
- Excellent organisation and prioritisation skills
- Effective communication skills, both oral and written
- Good people skills and ability to deal with difficult customers
- Good team player, building relationships that are open and constructive
- Ability to think proactively, plan, organise and prioritise own workload
- Good solution finding, analytical and decision-making skills
- Excellent I.T skills including Microsoft Office
- A desire to grow and develop in a challenging and progressive environment, including a willingness to study for and take relevant examinations
- A commitment to developing the role in line with the growth of the organisation
The role profile should not be considered an exhaustive list of responsibilities. You may be required to carry out other duties which are reasonably requested, according to the operational requirements of the company.
