Claims Acceptance Specialist
Claims Acceptance Specialist
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Job Description
About Avant
Avant Mutual Group is Australias leading doctors mutual. We are an organisation created by doctors for doctors.
We support over 85000 healthcare professionals and students with a range of products and services including medical defence and indemnity insurance. Our products are designed to protect our members both professionally and personally to safeguard their career and reputation and protect them and their families.
Our mutual structure heritage and ethos ensure that our members are at the centre of everything we do.
As our range of products expands tremendous opportunities exist to grow our business through acquiring new members and deepening our relationship with existing members.
About the Role
The role has responsibility for providing professional claims acceptance services by accepting or declining individual corporate and group claims in line with the terms and conditions of the relevant policy wording and documenting the decision.
Key Responsibilities
Claims Acceptance & Indemnification
Assess claims against policy wording and determine indemnification in line with Avant guidelines.
Review and record notifications of potential claims to protect Avant and its members.
Maintain a consistent approach to risk management and claims acceptance across the business.
Clearly document indemnification decisions including reasons for claim declinatures.
Ensure compliance with internal and external dispute resolution requirements and regulatory obligations.
Accurately code claims in accordance with policy clauses to minimize claims leakage.
Claims Process Improvement & Training
Assist the Operational Excellence team in enhancing claims handling processes and protocols.
Develop and deliver training sessions on claims indemnity and policy interpretation for internal stakeholders.
Participate in peer reviews to ensure national consistency in claims acceptance decisions.
Provide insights and recommendations for potential product changes.
Process Improvement & Change Management
Contribute to process improvement initiatives and proactively implement changes as directed.
Encourage a culture of continuous improvement and adaptation among team members.
Adhere to national frameworks and procedures ensuring alignment across the business.
Professional Development & Contribution
Stay updated on industry trends and maintain high professional knowledge and ethical standards.
Support and collaborate with team members to achieve departmental goals.
About You
Strong analytical and decisionmaking skills with experience in claims assessment and indemnification.
Indepth understanding of policy wordings risk assessment and regulatory requirements.
Excellent documentation and stakeholder communication skills.
Ability to train and mentor team members while driving process improvements.
Proactive and adaptable to change with a focus on continuous learning.
What We Offer
A collaborative and supportive team environment.
Opportunities for career growth in claims management and risk assessment.
Hybrid work flexibility in our Sydney CBD office.
A role where you can make a tangible impact on claims processes and member outcomes.
If youre passionate about claims management and process excellence wed love to hear from you! Apply now to be part of a team that protects and supports Australias medical professionals.
Other details
- Pay typeSalary
Required Experience:
Unclear Seniority
Employment Type
Full-Time
