Senior Claims Assessor/Brand Lead

Business Objective

Knose is dedicated to making Australian pets the healthiest and happiest in the world. A big goal? Maybe. But it’s what drives us to do what we do. And we’re taking steps to get there. Our mission is to ensure pets get the best care, and that they’re protected if something goes wrong.
Knose is taking a different approach to Pet Insurance – We want pet owners to understand their Pet insurance so ‘simple’ is our design principle. This principle guides how we constantly improve, make things simpler and clearer, whether it’s the product, our website and every email.

Overview

The Senior Veterinary Claims Assessor is responsible for evaluating and processing complex veterinary claims, ensuring accuracy, compliance, and fairness. This role requires extensive veterinary knowledge, strong analytical skills, and the ability to make informed decisions based on policy terms and conditions. The Senior Claims Assessor will also provide guidance and support to junior assessors and contribute to process improvements.

Key Customers

The key customers:

• Claims Manager
• Customer care Manager
• Head Vet
• Claims Team;
• Policy owners;
• Veterinarians and other clinic staff;
• Customer Care team.

Position Responsibilities

• Claims Assessment: Review and assess all claim types and pre existing condition assessments including complex, pre approval, complaint, escalated veterinary claims, surgical, medical, and routine care claims, ensuring they meet policy terms and conditions.
• Documentation Review: Verify the completeness and accuracy of submitted documents, such as veterinary records, invoices, and medical reports.
• Decision Making: Make informed decisions on claim approvals, denials, adjudication or adjustments based on thorough analysis and policy guidelines.
• Customer Communication: Communicate effectively via phone and email with policyholders and veterinary professionals to obtain necessary information and explain claim decisions. Communication of complaint outcomes
• Fraud Detection: Identify potential fraudulent claims and conduct investigations as needed, in collaboration with the claims manager
• Compliance: Ensure all claims are processed in compliance with relevant laws, regulations, and company policies.
• Quality Control: Conduct regular audits of claims processed by the team to ensure accuracy and compliance with internal policies and regulatory requirements
• Guidance and Support: Provide mentorship and guidance to junior claims assessors, assisting with complex cases and ensuring adherence to best practices.
• Coaching, Training and Development: Support with the training and development of new and existing team members
• Process Improvement: Identify areas for process improvement and contribute to the development and implementation of enhanced claims assessment procedures.
• White Label/Breeder: Ongoing management and support in our breeder program and partner brands
• Remediation: Assisting with the remediation of compliance issues as and when they arise
• Complaints: Review of claim complaints and handling of informal complaints communications
• Project work – Supporting senior leadership

Experience

• Doctor of veterinary Medicine, Bachelor of Veterinary science are preferred.
• Extensive up to date knowledge of veterinary terminology, treatments, and procedures.
• Basic Pet Insurance understanding

Skills

• Strong interpersonal skills, empathy, and optimism
• Ability to work autonomously and manage the working from home lifestyle
• Meet business KPI’s
• Intermediate Microsoft Office skills (Word, Excel) Or Google equivalents
• Excellent communication and interpersonal skills.
• Organised and able to meet deadlines
• Passion for change and innovation
• Strong analytical, decision making and problem solving skills.
• Ability to learn new systems quickly

Performance

• Accuracy: Maintain a high level of accuracy in claims assessment, with minimal errors or corrections required.
• Efficiency: Process claims within the established timeframes, ensuring timely resolution for policyholders.
• Customer Satisfaction: Achieve high customer satisfaction ratings by providing clear, empathetic, and professional communication.
• Team Support: Actively support and mentor junior assessors, fostering a collaborative and high-performing team environment.
• Continuous Improvement: Demonstrate a proactive approach to identifying and implementing process improvements, enhancing overall efficiency and effectiveness.
• Compliance: Ensure strict adherence to all regulatory requirements and company policies, maintaining compliance in all claims processing activities.

Values and Behaviors

It is expected that you represent Knose company values to the best of your ability. We believe the following 5 values underpin all our decisions to ensure they are in the best interests of our customers, our business and our communities.

• WE TREAT OTHERS as we wish to be treated ourselves–
• HUMILITY
• CLARITY simplify complexity
• HAVE A GO as long as its legal
• FLEXIBILITY WITH FOCUS – champions of the working from home life

Location and hours of work

Working from home flexibility. Training completed via online video conference.

SUPERVISOR/MANAGER:

Claims Manager