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Benefits Claims Assessor

Posted 8 September by Legal & General Ended

Principal Accountabilities:

  • Triage and assessment of new Workplace Health & Protection claims, determining what medical evidence to obtain in line with Legal & General’s philosophies.
  • Provide a comprehensive assessment of Workplace Health & Protection claims, deciding whether to accept or reject liability and authorise payment as per individual authority limits as agreed by the Head of Benefits, whilst meeting the expectations of the IFA’s and our corporate clients.
  • Develop and build effective relationships with IFA’s and Policyholders (employers), in order to maximise the effectiveness of our benefit management processes including the provision of support for the portfolio management of defined schemes.
  • Authorise expenditure on appropriate external medical evidence to support the assessment of individual claims up to £5,000.
  • Propose expenditure on rehabilitation or work re-integration programmes where there is a suitable cost/benefit justification for doing so.
  • Where appropriate, assist in the provision of Management Data on portfolio accounts which analyses performance and identifies key trends.
  • Train, mentor and develop other members of the benefits team, to improve their skill level
  • Ensure a consistent, timely and accurate level of service is maintained in line with service level agreements and promises made to meet customers’ expectations, and that are within scope of Legal & General’s Customer Experience and Treating Customers Fairly policies. Where failures are identified, provide information and feedback to the relevant areas to enable changes and improvements to be made.
  • Adhere to processes and systems to ensure that all customer data is dealt with appropriately in accordance with legislation, in particular the Data Protection Act (1995), the Access to Medical Reports Act (1988) and Legal & General’s Confidentiality Policy.

Qualifications:

  • The job holder is encouraged to obtain the Life & Disability Claims Diploma and the Group Risk GR1 module of the FPC qualification both of which are qualifications supported by the Chartered Insurance Institute.

Knowledge:

  • Knowledge of Income Protection, particularly Group Income Protection.
  • Good understanding of medical conditions and the effect these can have on an individual’s ability to work.
  • Awareness of the investigative and rehabilitation services provided by external organisations.

Specific Experience:

  • The jobholder requires legislative and regulatory knowledge including:

Finance Act 2004
Equality Act
Employer Law
DWP State Benefits
HMRC rules relating to Life and Pensions products
Data Protection Act
Financial Ombudsman Service

The Role is not regulated by the FCA, and the jobholder is not an approved person. However, the jobholder will be responsible for ensuring regulatory standards associated with the role are achieved at all times.

Skills:

  • The job holder requires excellent communication, both verbal and written, skills; analytical and risk management skills; ability to be creative and strategic thinking.
  • Strong claims assessment skills - particularly medical assessment.
  • Claims authorities: as agreed by Head of Benefits.
  • The job holder may represent the area at internal meetings.

Reference: 33265600

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