Claims Specialist

The Claims Specialist is responsible for advocating on behalf of clients on life insurance claims, including death, Total and Permanent Disability (TPD), salary continuance / income protection and trauma claims. The role provides technical claims advice and support, manages claims end to end with insurers, and negotiates outcomes on complex or contested claims. Working in partnership with Client Relationship Managers and Account Executives (Health & Benefits), the Claims Specialist helps ensure that clients and their employees receive fair, timely and well-supported claim outcomes, with a strong focus on service quality and sound claims governance.

The Claims Specialist is responsible for advocating on behalf of clients on life insurance claims, including death, Total and Permanent Disability (TPD), salary continuance / income protection and trauma claims. The role provides technical claims advice and support, manages claims end to end with insurers, and negotiates outcomes on complex or contested claims. Working in partnership with Client Relationship Managers and Account Executives (Health & Benefits), the Claims Specialist helps ensure that clients and their employees receive fair, timely and well-supported claim outcomes, with a strong focus on service quality and sound claims governance.

Responsibilities:
•    Manage a portfolio of group life, TPD and salary continuance claims for allocated clients, including major and complex claims
•    Act as the key claims advocate between clients, claimants and insurers, ensuring claims are lodged accurately and progressed in a timely manner
•    Review policy wording, definitions and eligibility criteria to assess coverage and advise clients on the likely claim outcome and appropriate strategy
•    Negotiate with insurers on behalf of clients to resolve declined, delayed or disputed claims, drawing on policy knowledge, case law and industry practice
•    Escalate and manage complex matters, including disputes with insurers and complaints, in line with internal governance and regulatory obligations
•    Provide technical support and guidance to Claims Administrators, Account Executives and Client Relationship Managers on claims queries and process questions
•    Communicate claim decisions and outcomes to clients clearly and sensitively, handling difficult conversations with empathy and professionalism
•    Monitor claims through to settlement and confirm that benefits are paid to claimants, either directly by the insurer or through WTW
•    Prepare claims experience reports and provide insights to clients and internal teams on claims trends, reviews and audits
•    Contribute claims expertise to client renewals, market reviews and tender responses
•    Maintain accurate and complete claims records, file notes and reporting in WTW systems
•    Build and maintain strong working relationships with insurer claims teams, clients and internal stakeholders
•    Identify opportunities to improve claims processes and service quality, and share knowledge to support the development of less experienced team members

The Requirements

•    Proven experience in life insurance claims management within an insurer, broker or claims advisory environment in Australia
•    Strong knowledge of group life, TPD, salary continuance / income protection and trauma claims, and the Australian legislative and regulatory framework that applies to them
•    Comprehensive understanding of policy wording, definitions, exclusions and coverage, and of claims assessment and adjudication practices
•    Demonstrated experience negotiating claim outcomes and managing disputed or complex claims
•    Tertiary qualification or progress towards a relevant professional insurance qualification (for example, ANZIIF or equivalent)
•    Ability to meet all regulatory, licensing and compliance requirements applicable to the role under Australian legislation
•    Excellent influencing, negotiation, written and verbal communication skills, with the ability to explain technical concepts clearly to clients
•    Ability to build strong, collaborative relationships with clients, insurers and internal teams
•    Empathy, sound judgement and discretion when handling sensitive claims involving serious illness, injury or death
•    Strong organisational skills, attention to detail and the ability to manage a varied workload and competing deadlines
•    Coaching and mentoring skills to support the development of team members
•    Competent in Microsoft Office applications (Outlook, Excel and Word)

At WTW, we believe that a culture of inclusion and diversity is critical to our business. It's not a separate initiative – rather it’s fundamental to everything we do. We are an equal-opportunity employer who is committed to fostering an inclusive work environment and embrace diversity including gender, nationality, disability, age, marital/parental status, ethnicity, gender identity and sexual orientation. We welcome applications from people from all backgrounds. 

In the spirit of reconciliation Willis Towers Watson acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today. 

We’re committed to equal employment opportunity and provide application, interview and workplace adjustments and accommodations to all applicants. If you foresee any barriers, from the application process through to joining WTW, please email candidate.helpdesk@willistowerswatson.com