Senior Claims Operations Consultant

• Managing and executing escalated decision activities in line with defined process standards, collaborating with key internal stakeholders, and using insights to uplift team knowledge and reduce future escalations.
• Providing expert support to the CI team in handling declined claims, responding to complex member enquiries, and managing complaints with professionalism and empathy.
• Acting as a subject matter expert in CI systems and processes
• Assisting the Senior Manager, Claims Operations in daily workflow allocation, with a focus on timely handling of urgent and declined matters.

• Manage internal escalations and complaints, seeking expert input where required to ensure accurate and timely resolution.
• Oversee daily workflow allocation, ensuring tasks are distributed evenly to the CI team.
• Monitor urgent matters and the Notice of Intention (NOI) line to enable real-time issue resolution.
• Support the Senior Operations Manager in implementing and executing training and development plans.

• Provide continuous technical guidance, coaching, and constructive feedback to the Claims Intake (CI) team to:
• Apply logic-driven process standards to determine objective indemnity decision outcomes.
• Make and document subjective decisions based on product and policy rules when objective outcomes are not possible.
• Manage declined and withdrawn indemnity decisions directly with members, ensuring clear communication and resolution.
• Promote a culture of learning and improvement by offering timely, respectful, and actionable feedback to Claims Intake and Claims Excellence Teams and Product.

• Provide dedicated contact point for all notifications (incident or claim) and support member to indemnity decision outcome, building rapport, representing Avant professionally, leveraging our Service Principles throughout all interactions with members
• Review, evaluate and process member enquires to appropriate owner.
• Proactively manage end to end case management within Service Levels

• Demonstrated technical expertise with deep understanding of claims process and indemnity assessment.
• Proven ability to coach effectively to process adherence, provide constructive, timely feedback and guidance that supports team learning, builds confidence, and enhances overall capability.
• Strong written and verbal communication, with ability to explain complex decisions clearly.
• Proven ability to work effectively with internal stakeholders and contribute to positive team culture.
• Strong analytical skills and sound judgement in resolving complex or escalated matters

• Understanding of Medical Indemnity insurance
• Understanding of Medico Legal claim types
• General understanding of medical terminology preferable
• Experience in coaching or team leadership preferred.

Avant Mutual Group