Job and Person Specification Approval. 1. Summary of the broad purpose of the position in relation to the organisation s goals

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1 South Australian Public Service JOB AND PERSON SPECIFICATIONS Title of Position: Senior Claims Assessor Classification Code: ASO6 Discipline Code: Administrative Unit: Department of Treasury and Finance Branch: Super SA Section: Claims Management Career Code: Type of Appointment: Position Number: Ongoing Position Created: Temporary Other All excluding senior positions Job and Person Specification Approval....../.../... CEO or delegate JOB SPECIFICATION 1. Summary of the broad purpose of the position in relation to the organisation s goals The Senior Claims Assessor is accountable to the Manager, Claims Management for the accurate and timely medical assessment of death and disability claims and underwriting applications. The incumbent is also responsible for the delivery of a comprehensive claims management information service to claimants and for identifying key policy issues, trends and contributing to continuous improvement (best practice claims processes) of claims management across Super SA. 2. Reporting/Working Relations Reports to the Manager, Claims Management. Works closely with Claims Management Officers. Liaises with all Super SA management and staff. Has extensive contact with internal and external customers (staff within Super SA, members, agency staff and external medical / legal parties). Page 1

2 3. Special Conditions Some out of hours work may be required. required. Occasional intrastate and interstate travel may be The incumbent will be required to participate in the Departmental Performance Management Program. The incumbent may be required to be assigned to other positions at the same remuneration level across the department. An individual recommended for appointment/employment to a position in DTF will be subject to satisfactory criminal history/record check in accordance with the DTF Pre-Employment Screening (Criminal history/record check) Policy and Procedure. Disclosure of any pending charges is also mandatory. Previous criminal conviction or pending charges will not necessarily preclude employment. 4. Statement of Key Outcomes and Associated Activities Accountable for contributing to the successful achievement of Super SA s business objectives by: 4.1 Delivering a claims and underwriting management function by: Participating in the development of business plans and operating frameworks. Participate in or leading claims management policy, procedure and system improvement projects. Managing the accurate and timely medical assessment of Death, Total and Permanent Disablement and Income Protection claims in accordance with the relevant legislation. Managing the accurate and timely medical assessment of underwriting insurance applications in accordance with the relevant legislation. Liaising with professional experts (both internal and external), in writing and verbally, to gather information, analyse and investigate issues. Ensuring the accurate communication (both internally and externally) of claims and underwriting decisions and insurance related matters, in writing and verbally. Advising and assisting in the resolution of complaints, external dispute resolution and litigated matters. Providing specialist information, consultancy and training service to agencies in relation to the underwriting and claims management processes. Building effective networks and partnerships with managers/supervisors, injured employees, medical practitioners, external providers, and union / legal representatives, financial advisors. Exercising Super SA Board delegations. Achieving Service Levels Standards. Maintaining accurate and confidential files and documents within the established record keeping systems to ensure the Office s record systems comply with public sector and statutory requirements. Advising on best practice claims processes, promoting and embedding these skills in the team. Collecting and accurately reporting on relevant data to assist in the measurement and monitoring of the performance of the Claims Management Unit. Provide coaching to Super SA staff on claims management and service delivery. Identifying barriers for achieving best practice outcomes and developing effective and practical strategies. Page 2

3 4.2 Ensuring that Procedure, Policy and Enterprise Architecture documents are maintained in a state which represents current operational practice. 4.3 Contributing to the promotion and implementation of the Principles of Personnel Management and in particular Equal Opportunity, Occupational Health Safety and Welfare and the Merit Principle by adhering to the provisions of various Acts and associated legislation. Acknowledged by Applicant....../.../... Page 3

4 PERSON SPECIFICATION Essential Minimum Requirements Educational/Vocational Qualifications N/A Personal Abilities/Aptitudes/Skills Proven ability to work independently within guidelines, while meeting critical deadlines and utilising excellent attention to detail skills. Proven ability to effectively communicate, influence and negotiate with a diverse range of clients at various levels (both verbal and in writing). Proven ability to objectively deal with sensitive and contentious matters and maintain confidentiality, tact, sensitivity and empathy when communicating with internal and external customers. Ability to develop, implement and evaluate strategic initiatives, especially as it relates to claims management. Experience Experience in assessing complex information and make recommendations on Death, Total and Permanent Disablement and/or Income Protection (salary continuance) insurance claims and underwriting applications. Demonstrated experience in managing complex life insurance or income protection claims including assessing, investigating, reviewing, negotiating and determining entitlements. Experience within a retail and/or group life insurance or workers compensation claims assessment role. Experience in providing expert advice and working in a customer service environment in situations with demanding and changing workloads. Experience in the interpretation, adherence and application of legislative requirements within the life insurance industry or other similar workplace. Knowledge Knowledge of medical and legal terminology associated with the factors influencing the management of injuries/ illnesses. Knowledge of the group life insurance, superannuation or workers compensation industry. An awareness of the relevant legislation, policies and procedures, including Code of Conduct, EEO and cultural inclusion. An understanding of and ability to work to the spirit and principles of the Premier s Safety Commitment and the legislative requirements of the Occupational Health, Safety and Welfare Act. Page 4

5 DESIRABLE REQUIREMENTS Educational/Vocational Qualifications Diploma in Life Insurance or similar course. RG146 (for the superannuation industry) compliant. Personal Abilities/Aptitudes Skills Ability to identify, assess and positively implement continuous process improvement changes. Ability to contribute to policy formation and towards the strategic direction of the business. Experience Claims assessment experience in the health or allied health industries. Underwriting experience within the group life insurance, health or allied health industries. Experience in handling disputed and/or litigated matters. Knowledge N/A Acknowledged by Applicant....../.../... Page 5

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