Case Manager Leadership level Leading Self Job level 3 Job family Division / department Reports to manager job title Number of direct reports Financial accountabilities Key relationships Location of role Insurance Specialisations Insurance Operations Claims Claims Manager Nil Nil Immediate peers, Team Leader, Team Manager, Case Managers, internal and external clients, medical partners, internal and external Trustees Melbourne / Sydney (Parramatta) The AMP Promise & Our Strategy to Help AMP s vision is to be Australia s and New Zealand s favourite financial services company by 2020. Our company was founded in 1849 on a simple promise - to provide financial security so people could live with dignity. Our promise is to help people own tomorrow. Helping people: it s why we began more than 160 years ago, and why we continue. Helping people own tomorrow is a powerful purpose. It has the capacity to make us the company that so many people trust and recommend that we become Australia s and New Zealand s favourite financial services company. That s what we are aiming for by 2020. AMP s Culture Bringing our Promise to life Our Promise is help people own tomorrow, and our Practices bring our Promise and customer experience to life. AMP s six simple practices were formed from really listening to our customers, and they define the way we work together to help our customers. They inform our thinking, actions and decisions; the design of every offer, process and system; and every customer experience.
Together, the six AMP practices describe how we work at AMP to deliver the experience our customers want: Our customers are at the core of AMP s culture. We believe that what s best for our customer is what is best for our business. We have profound empathy for our customers. We deeply understand their needs, goals, challenges and hopes. We re obsessed with helping our customers live their best life, because that s how we define our own success. AMP employees understand how their work contributes to the strategy and creates customer value. Professionalism and integrity are core to the way we work, we collaborate across the business in service of our customer. We eliminate non-value work that doesen t align and quickly learn and adapt to achieve better outcomes.
Description of department/division AMP is structured around two businesses, AMP Financial Services and AMP Capital Investors. AMP Financial Services provides customers in Australia and New Zealand with: Financial planning and advice Superannuation, retirement income and other investment products for individuals Superannuation services for businesses and employer-sponsored schemes Income protection, disability, and life insurance Selected banking products The Operations division has more than 1,400 employees located across five sites with responsibility for enabling thousands of customers and advisers to access quality financial advice from Australia's largest non-bank wealth provider. The Insurance Operations team is responsible for all operational functions of insurance, including new business, servicing, underwriting, and claims operations. The claims operations function is responsible the assessment, management and administration of all retail and group insurance claims. AMP has recently begun a journey to transform our claims experience to become more customer centric. This new approach will see our Case Managers and claims teams work with a wide range of stakeholders while gathering and interpreting a wide spectrum of information. Our Case Managers are supported and empowered to make claim decisions and to develop case management strategies that proactively assist our customers in realising their best life. Purpose of the role Case Managers are responsible for the holistic and end to end management of claims. This includes assessing and interpreting a wide spectrum of information to make claim decisions and to develop case management strategies that proactively assist our customers in realising their best life. The Case Manager must manage claims in a consistent, pro-active, fair and ethical manner, in line with AMP s Claims Philosophy, Core Beliefs and Model. The Case Manager engages in effective communication with all stakeholders throughout the claims process relying on active listening and empathy to identify the customer need and devise an effective and personalised case management strategy. The products and claims types Case Managers will manage include but are not limited to: Death Claims Terminal Illness Total and Temporary Disablement Trauma Income Protection & Salary Continuance Main focus areas Core Claims capabilities Holistic Claims Management: Considers focus on function and capability in all decisions Identifies all impacting factors and creates strategies with return to work in mind Manages duration control, putting in practice strategies to effectively control claim duration Conducts proactive case management to assist customers to realise their best life
Customer Commitment: Collaborates with and educates customers to create trust and achieve shared goals Demonstrates empathy for customers and manages expectations Effectively manages complex conversations and situations to ensure optimal outcomes for customers Communicates regularly with customers to keep them informed and focused on mutual claim goals Stakeholder Engagement: Understands and communicates the role and function of all stakeholders in the holistic claims management approach Collaborates effectively with all stakeholders to identify all influencing factors of a claim Collaborates effectively with all stakeholders to develop and implement and adjust case management plans that support customer s realising their best life Balancing Metrics & Quality: Achieves balance between own productivity and deliverables, and optimal claims outcomes Manages and measures own outputs in relation to customer outcomes Skills and behaviours - role specific Additional Case manager specific capabilities and skills Excellent verbal and written communications Effective time management, prioritisation and workload management Strategic, analytical assessment and decision making Managing financial outcomes Teamwork and cross enterprise collaboration Group facilitation and influencing skills Developing and coaching others Personal and career development and initiative Resilience and social intelligence Holistic, end to end Claims Management activities and behaviours Accepting new case referrals and retrieving all relevant case related information from relevant information systems Reviewing initial case information and understanding case details including customer s claim history and condition being claimed Proactive communication with the customer to evaluate the customer s history, medical treatment, level of function and abilities, social network; uncover all bio psychosocial influencing factors potentially impacting the claim; understand the customer s beliefs and self-efficacy and expectations of appropriate work accommodations to facilitate return to work Implementing the case management plan activities within the timeframes noted to proactively drive the case toward the optimal claim outcome Proactive communication with the employer to gather information on occupational demands and duties, collaborate on possible workplace accommodations and return to work (RTW) options, assess workplace related influencing factors potentially impacting the claim, and confirm at work requirements if needed Where appropriate, partnering with healthcare providers to exchange information around function and occupational details, relevant work accommodations, and any relevant impacting factors. Constructs targeted and concise requests to treating doctors and Independent Medical Examiners Holistic review of the case, incorporating all available information, against terms and conditions of the policy
Positively engaging the customer to empower, educate and develop trust in order to build customer commitment to case goals and enable a transparent and multi-disciplinary case management approach delivered in partnership with the customer Developing impactful case management plans by formulating evidence based strategy for managing the case toward the optimal claim outcome Assisting customers in reaching appropriate milestones including setting and managing expectations related to bps factors Creating communications that are accurate, simple and fully address specific needs of the case Ongoing and disciplined completion of administrative tasks such as waiver of premium, raising and closing payment requests, raising closure requests, setting review triggers, effective complaints handling, writing and storage of all file related correspondence and portfolio reporting Determining initial and ongoing eligibility and entitlement to benefits Positively communicating claims decisions to all relevant stakeholders, including explaining assessment against the terms and conditions of their policy, offering direction for assistance when claim denied, and preparing and sending written confirmation of decision and applicable payment details using standard letters customised to needs of the claim Ability to clearly summarise and present case chronology and strategy to both internal and stakeholder groups as required Reporting on portfolio trends and statistics as required Ability to consistently achieve set service standards Knowledge requirements To successfully execute all components of this role, the incumbent should have, or be able to develop, a solid working knowledge of the following: Strategies: Holistic claims management Complex Communication Strategies Functional interviewing Telephone interviewing Workplace accommodation Return to work and Settlement Strategies Specialty Areas Assessment of Bio psychosoical factors Medical Financial Insurance Legal and regulatory environment Investigations Occupational health Rehabilitation models and process
Experience required Strong claims assessment or case management experience Broad knowledge of one or more specialty areas including medical, financial, legal, investigations, occupational, and rehabilitation models and process Experience in strategically assessing medical and/or disability claims Understanding of the Risk Insurance market and associated products will be advantageous Qualification/s required Qualification in case management, insurance or related medical fields are considered advantageous