Job Description
As a Claims Agent, you will play a vital role in supporting the delivery of high-quality service and operational excellence across our many schemes, brands and products. Focused on Claims processing and assessment, you will work under the guidance of the Team Leader to carry out tasks with accuracy, effectiveness and efficiency. For more senior roles, you will be making claims decisions, in line with policy, regulatory requirements and assigned accountabilities.
Your role will be assigned to either be the point of contact for our customers, often front line, delivering exceptional service across multiple communication channels including phone, email, and digital platforms. You will play a key role in ensuring a seamless customer experience by resolving queries efficiently, accurately, and with empathy. Alternatively, your role may be assigned to be part of the claims processing teams, offline, performing critical work to ensure effective operational processing, or in some cases may be a combination of these roles.
In all cases, you will work collaboratively within a team focused on high performance and strong execution effectiveness to meet service level agreements (SLAs), KPIs and targets as assigned, and contribute to continuous improvement initiatives, upholding the company’s values in every interaction and action.
Above all, you will help deliver fair and consistent claim outcomes through clear, principle-led communication, whether over the phone or in writing, delivering productively to company targets.
Key Responsibilities
• Handle inbound and outbound customer interactions across voice, email, and digital channels as assigned.
• Resolve customer queries and complaints effectively, ensuring high quality first-contact resolution where possible.
• Deliver claim outcomes through clear, professional, effective and empathetic conversations, guided by principles (or scripts dependant on local law). In all cases the quality and “tone of voice”, whether in writing or over the phone, must meet or exceed the standards set out.
• Accurately log and update customer interactions and all operational tasks in the company systems.
• Follow standard operating procedures and adhere to regulatory and compliance requirements.
• Complete assigned tasks within agreed timeframes and quality standards.
• Follow work allocation plans and prioritise tasks effectively, understanding customer and business needs.
• Meet or exceed individual performance targets including quality, productivity, and customer satisfaction.
• Participate in regular coaching, training, and team meetings to support personal and team development.
• Contribute to a positive, inclusive, and collaborative team environment.
• Identify, contribute to and/or suggest opportunities for process improvements or service enhancements.
• Review and process claims in accordance with the policy wording and as defined by the Insurer, based on your agreed authority levels and duties assigned.
• Where a claim is admissible or declined ensure that a detailed explanation is given and to follow this in writing where requested.
• Accurately assess all claims and respond to claimant with concise communications detailing all further information/documentation required to proceed with claim or giving full explanation of claim outcome, effectively describing the settlement or reasons for decline.
• Ensure all recovery aspects of claims are identified, monitored and amounts due are obtained where appropriate.
• To accurately prepare, assess and where needed, input claims documentation related to payments to either clients or third-party suppliers, into the company systems.
• Ensure any potential fraud indicators are identified and acted upon.
• Maintain accurate records and documentation in line with regulatory and procedural requirements.
• Support the team in achieving performance targets and service level agreements.
• Invoke escalation and referral procedures and routes where…