Senior Claims Consultant

As a leading global reinsurer, SCOR offers its clients a diversified and innovative range of reinsurance and insurance solutions and services to control and manage risk. Applying "The Art & Science of Risk," SCOR uses its industry-recognized expertise and cutting-edge financial solutions to serve its clients and contribute to the welfare and resilience of society in around 160 countries worldwide.
Working at SCOR means engaging with some of the best minds in the industry - actuaries, data scientists, underwriters, risk modelers, engineers, and many others - as we work together to find solutions to pressing challenges facing societies.
As an international company, our common culture is defined by "The SCOR Way." Serving both to build momentum that drives the Group forward and as a compass to guide our actions and choices, The SCOR Way is anchored by five core values, reflecting the input of employees at all levels of the Group. We care about clients, people, and societies. We perform with integrity. We act with courage. We encourage open minds. And we thrive through collaboration.SCOR supports inclusion and the diversity of talents, and all positions are open to people with disabilities.
As a Senior Claims Consultant, you will be responsible for claims management, client servicing, product design/review and audits for the Australian and New Zealand markets for the Company to ensure client support meets its goal to be: A respected, customer-focused underwriting and claims team in developing and delivering work, to enhance SCOR’s ability to write profitable business.
Key duties and responsibilitiesMain scope: The role will enable client focused solutions and covers a number of areas:Claims Assessment and PhilosophyClaims Data ManagementClaims Technical and Operational reviews.Relationships and Training SupportProduct & Pricing SupportIndustry representationRisk and Compliance
1. Claims Assessment and Philosophy To maintain the company’s claims policy and principles, ensuring risks admitted are sound and within the terms of the policy. Ensure effective oversight and manage high financial impact of large claims on receipt of claims referrals and applies claims decisioning to creates strategies to influence the most appropriate outcomes.To support our clients in expediting claims with their customers as efficiently and effectively as possibleEnsure underwriting and claims basis conforms to SCOR Global Life underwriting and claims guidelinesReviewing claims documentation: They review the claims documentation to ensure that it is complete and accurate, and that the claim meets the policy terms and conditions.Senior claims managers assess complex or high-value claims, working with underwriters, and other stakeholders to determine the cause of the loss and assess the claim's validity.
2. Claims Data ManagementAnalysing claims data: They analyse claims data to identify trends, patterns, and potential fraudulent activity, and develop strategies to mitigate risks and improve claims handling processesCedant bordereaux data analysis to assist in building claims intelligence about claim portfolios across Cedant claims.Use the assessor tools for exceptions observed with product rules, benefit payment analysis, reserves, and bordereaux approval rules to automate identification of outliers for claims requiring additional attention.These exception rules are set to determine claim outliers that may require additional oversight and should feed into the operating model of on-site client support.Ensure earlier identification of issues or areas of concern in client capabilities or decisions, creating a risk-based approach to ensure validity of decisions made.Provides data insights into the quality of the cases referred, allowing SCOR to identify areas of strength and areas of development and training needs.
3. Claims Technical and Operational reviews Maintains case file reviews to provide feedback and recommendation in relations to technical decision making. This approach supports SGLA and its clients in the effective management of claims outcomes and will inform capability uplift requirements.Provides insights and support for our clients’ management of businesses more holistically. These operational review processes should examine the practices, policies, and guidelines, helps support the underlying root cause of errors, if any.
4. Relationships and Training Support Participate and maintain strong relationships with our clients and their claims teams including regular onsite support in our client’s officesWork closely with business development team to enhance client relationships and new business opportunities.Maintain interaction with other departments across SCOR (e.g. actuarial, business development) in order to contribute to multi-function projects.To liaise closely with Head Office, to ensure conformity with SCOR Underwriting and Claims guidelines.Through reviews highlight areas for capability improvements, identifying skills gaps to be addressed.Deliver training to enable clients to maintain high technical standards, including development of new material.
5. Product & Pricing SupportProvide feedback and input to adapt our product development, pricing and valuation processes as appropriateOn new tenders or renewals of business terms participate actively in pricing considerations, client expertise in claims, product terms and conditions and impacts and other influencing factors.
6. Industry representationRepresent SCOR Global Life Australia on topics through active involvement in thought leadership pieces within our newsletters and publications, industry groups, clients and other select special engagements.
7. Risk and ComplianceIdentify key control issues/risks where applicableEnsure adherence to SCOR policies, processes and external regulatory and legislative requirementsManage all risks and audit issues effectivelyTo have an understanding of the need to mitigate business operational risks in line with established risk management and compliance frameworks

Required experience & competencies
Experience: Minimum 5 years of relevant working experience in insurance/reinsurance fields, in areas of claims, including financial assessments.Experience using Microsoft Outlook, EXCEL, ACCESS, POWERPOINT and PRESENTATIONS.
Required Education ACII, LOMA, CLU or other relevant professional qualifications, and/or a commitment to the continuous learning required in a constantly evolving environment.
Personal Competences:Strong technical skills in claims assessmentStrong Financial Assessment skillsStrong Medical TerminologyExperience in Rehabilitation and Return to Work ProgramsLegal Acumen and knowledgeExcellent communication and interpersonal skills with colleagues clients and contacts,A good advertisement for the business,Desire to learn, help and work as part of a small teamTeam playerWillingness to take on new challenges/work outside their comfort zone.