Claims Specialist

Responsibilities

The Claims Specialist manages a portfolio of life insurance claims, acting as an advocate between clients and insurers to ensure fair and timely outcomes. They are responsible for negotiating complex claims, providing technical advice, and maintaining accurate records in accordance with regulatory obligations.

Requirements

Candidates must have proven experience in life insurance claims management and a comprehensive understanding of Australian legislative frameworks. Strong negotiation, communication, and analytical skills are required, along with a relevant tertiary or professional insurance qualification.

Skills

• Life insurance claims
• TPD claims
• Salary continuance
• Income protection
• Trauma claims
• Claims advocacy
• Policy interpretation
• Negotiation
• Dispute resolution
• Regulatory compliance
• Claims governance
• Stakeholder management
• Technical reporting
• Mentoring
• Microsoft Office

Benefits

• Inclusive work environment
• Equal opportunity employer
• Workplace adjustments and accommodations

About this role

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

RESPONSIBILITIES

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QUALIFICATIONS

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
[candidate.helpdesk@willistowerswatson.com]

About WTW

Financial Services · 10,001+ employees · headquartered in London, England