Complaints & Escalations Claim Specialist

Reporting into the Outsource Vendor Manager, CL you will be the primary contact for complaints and (escalated) claim inquiries. You will resolve formal complaints and additionally, will track escalation data for operations and reporting purposes and propose settlement agreements. Oversight of the business’s Complaints Claims Assessment system and processes.

Duties and responsibilities in this job

 Oversight of our Complaints Claims Assessment system and processes.

 Manage multiple issues/cases at one time simultaneously based on workload.

 Accurately, independently and fairly assess and review claims and complaints conduct claims reviews on high value claims

 Identify and escalate serious or urgent cases to the MD.

 Communicate with medical advisor, to discuss medical conditions and complex cases where required and report findings.

 Ensure that Service Levels Agreements, Internal and Regulatory timelines are met.

 Required to log and track each issue in multiple tracking systems for the purpose of generating reports.

 Maintain a high level of Complaint-handling skills, following agreed service level agreements, contracts and against policy conditions.