CLAIMS CONSULTANT INTERVIEW

Question 1

What are the key responsibilities in this role and how would you fit into that?

Answer 1

• An LTC Consultant would be in charge of managing a portfolio of 120+ long term claims.
  
  • They would be in charge of requesting medical and claim forms from the members, doing progress calls and any other potential documents such as payslips.
  • Using this information they would assess the 6 key elements of the claim to then make a recommendation to raise payments. You also look for any potential progression with the claim and if things like rehab would be suitable.
    The LTC claims that would be managed within this role would be from the CORP and UNISUPER funds so a claims consultant would need to have good knowledge of those policies in order to make the right decisions on their claims.

Question 2

What are your strengths

Answer 2

• My organisation skills. I am very system based and routine orientated. There’s alot of different business processes that we have to remember. So I have a system of recording everything down if i’ve done it for the first time. I’ve created a system for myself that’s very easy to manage so that I’ll always be able to help myself through any query or at least have a go at it. This has also made me handy in helping others as I’m able to just refer to my notes and provide assistance that way. For example the step by step process paying an invoice or setting up an external sharepoint, even templates of any emails, letters, offset tables I have them saved into my system and ready for reference using my trusty one note. Big reason why I made sure that the IT had that data transferred over.
  
  • My communication skills. I can credit alot of the great relationships I have within the team through my communication skills, allbeit online, it has nonetheless been super helpful to me settleing in well. More importantly this has helped in my customer service skills, I’ve been able to demonstrate this through my calls with some of my members for a progress update where even through one phone call i’ve managed to build a good rapport with my member.- focus more on this and how it’s gonna be a big part of the ltc role. Being able to build a good relo despite having so many claims. This customer service has also come in very handy whenever i receive calls in regards to issues, such as providing assistance in accessing files or clarifying certain payments or ongoing requirements.
    Passionate learner and worker - I always try to give my best whenever learning something new or taking on a new experience. i’m very trainable, big fan of feedback and anything that can help me improve myself to get better.

Question 3

What are your weaknesses

Answer 3

I’m a yes man. I can at times take on more work or say yes to tasks without having the best gauge of where i’m up to with my own tasks or how exactly to navigate through that task. I am working on this by trying to have a better understanding of my day on how i’ve planned to navigate through it and whether or not I will have the capacity to provide assistance. In terms of working through a difficult task, I always like to give things a try of course with caution by using my own resources, looking at previous examples or situations or referring to or online resources. I know that when you have 120+ claims in your name I won’t always be able to put my hand up to say yes I can help so that will be my focus to improve on. Although i’d love to always be able to lend a helping hand whenever I can. Having a firm understanding of my capacity and the assistance that I can provide or requesting the assistance that I need.

Question 4

Why do you want this position and how would you excel in this position?

Answer 4

• I believe that my in-depth training and experience in working with both Melbourne 1 and 2 would really help me to succeed in this claims consultant role.
  
  • As you know i’ve undergone the two weeks induction training and regular shadowing sessions with the claims Consultants. My shadowing experience with Joey and Mary has really helped me to get an understanding of how an assessor thinks as I’ve worked through heaps of ongoing assessments of IP claims with ranging complexities. They’ve also set the standard of what to expect in an assessment and how the entire process of receiving information, assessing that information and making a decision based on that. I’ve also been able to get sessions in with Ben and Jeremy who have walked me through the same thing but moreso on the GASP platform and how to navigate which is slightly different from CARE.
  • I learn best when I actually apply what i’m learning and this is the exact experience I was fortunate to have since I’ve been managing my small portfolio of long term claims. This gave me the autonomy to really think for myself and to really implement all those concepts that i had gone through in all my training.
  • I believe that this combined with my Admin experience which will still play a big part in my day to day in terms of tasks and an understanding of workloads would really help me to succeed in the role of a long terms claims consultant.
    On top of this one of the more intangible assets that I would like to mention is my already established connection with the team, the relationships that i’ve developed and the understanding of the culture that you’ve cultivated in m1 to get it done. I believe that this will really put me in a position to succeed and be an asset to the team by taking that next step into this role.

Question 5

Tell me about a difficult situation that you were able to overcome.

Answer 5

• On one of my claims my member had actually passed away whilst on IP DD and I was only informed of this almost 2 months after the member had passed away so there was definitely an overpayment.
  
  • When I checked the claim to see the overpayment I realised that we actually had one of the payments going out that same day so I had to take quick action to cancel the payment which was successful so we only had an overpayment of 15 odd days which is better than a month and 15 so that was clutch.
  • After that I had to figure out if a death benefit was payable to the member so I went through the policy but wasn’t able to find anything. Which is when I learned that for corporate claims, the vitality PDS takes precedent if anything is omitted from the regular schedule. So this is how I found there was a death benefit payable of 3x that of the monthly benefit, which was great because we could offset the overpayment from this amount.
  • I went ahead and started going through the calculations with our techhy, so we calculated how much was overpaid and what we were gonna deduct from the death benefit.
  • The next step was to pay the amount which was usually payable to the fund, but in contacting the fund they actually refused to accept the payment because the member was technically no longer employed with them anymore.
  • So the next person to go to was the spouse who I was able to have a chat too just to confirm who she was as well as the fact that the bank details were a shared account.
  • So we were ready to make the payment via eft as advised by the tech, but the senior actually stepped in and told me that this amount has to be paid through cheque because it’s going to the spouse but we need the will and probate before we can pay this amount to confirm our risk and ensure that the cheque can be cashed. This all actually conflicted with what the tech was saying and she basically said it’s up to me on how I should go about it. So I was like oh okay…
  • I contacted the wife again to confirm that her husband’s estate had been set up and that the will was written because we hadn’t got any actual hard confirmation aside from a google search - so she told me to actually get in touch with her lawyers whom she hadn’t mentioned till this point.
  • I brought this back to the tech and senior who were both more than happy to pay the amount via cheque to the lawyers who have set up the probate and will and everything else and would have a true understanding of the beneficiaries and such. So I sent them over that cheque payable to the late member’s estate and closed of the member’s claim.
  • But I guess the highlights of the story is all the little intricacies that can actually take place during each step of a claims process. There was a quick action we had to take with the overpayment, there was a sneaky vitality policy which i didn’t know about till then and there was the final issue of who and how the payment was going to be made. But I was able to navigate through it by utilising the correct resources and speaking with the right people to make sure that I always considered all my options in each step of the process.
    And Actually in the past week I’ve had a member pass away recently and this one has gone 10x smoother than the last one because i’ve been able to record the entire process down and have a strong understanding of it now.

Question 6

Tell me about a time you showed initiative

Answer 6

• There was a time one of the claims consultants was getting absolutely smashed and had a full on day and had shouted out for help in the huddle for writing up and sending out three TPD Decision or Acceptance letters and no one had really volunteered. So I actually put my hand up to help him out because I thought you know it was just 3 letters right…The techhy commended my initiative but kind of cautioned me to ensure that the letter was reviewed by the cm first because a TPD letter, is abit different from the standard IP letters which I was used to sending out, it has alot more of the assessment information included because you have to kind of break it down to the fund and justify your decision which requires a much more indepth understanding of the claim.
  
  • I had a quick chat to the claims consultant and asked for some previous examples of TPD letters, had a quick read and analysed what key points they would try to include which was pretty much a summary of each of the 6 claims elements but worded together nicely to justify whether the member was or wasn’t TPD.
  • After noting down those key points I looked at the CAP and was able to get alot of the information from there but actually referred to some of the medical documents, Ms, position description and MD guidelines just to get a better understanding of the claim and how I would word everything in the letter.
  • I was able to write the whole thing up using all that information and the template i had formulated from the sample letter the consultant provided. I sent it over to the claims consultant for review who was pleasantly surprised.
  • He told me he was really happy with the letter and actually made no changes on any of the sections that I put in. And so I sent it over to the fund. I was like well great that worked, copy pasted the exact same process for the two other letters. No changes when sent for review, And I was able to get them over to the fund and that was that.
    So I volunteered at something I was pretty unfamiliar with and a little bit in over my head, but nonetheless had a go to help out a fellow employee. I was able to use my resources and claims assessing skills plus all the hours of writing up letters and emails to get it done and get it done right.

Question 7

Tell me about a time you went above and beyond.

Answer 7

• There was this one AFCA complaint on a TI claim. The TPA was the spouse of the member and was obviously going through a very difficult time.
  
  • Unfortunately there relationship was further soured with TAL because they were unhappy at our response times and the time it took for us to provide information so that was kind of the scene.
  • Pretty much I had to send over something like sift through the member’s claim documents which had over 140 documents and had to pick out 90 odd documents ensuring that no internal comms was included but all corro’s exchanged with the TPA mbr and other insurer AMP was included.
  • I had to password protect each and every document and work with the process improvement and automation manager to create an external file sharepoint as there was no way could 300mb could be sent through email .
  • It is to this sharepoint that I would upload all the documents and then provide the access link to the TPA. Unfortunately the process of accessing is quite complicated so I provided a very detailed email with the instructions of how to go about accessing the link which involves microsoft verification and such.
  • It turns out the TPA is not tech savvy, and required major assistance with this process. So I was able to go with them through all the instructions over the phone and eventually getting them access.
    After this the TPA had actually commended me for all my help and efforts. She was very happy with how quickly I would respond and how I proactively assisted her throughout the whole process. Even though she was putting up a complaint I knew that her and her family were going through a difficult time So I made sure to go above and beyond to provide the best customer service to them.

Question 8

Can you detail a mistake you made and how you reacted to it?

Answer 8

• When I was newer to TAL, I made a mistake on one of the letters I sent out in the ongoing requirements.
  
  • I misinterpreted what the Claims Consulted said in their CAP in terms of requesting the PADS.
  • The member was unhappy because they had just completed a PADS and they emailed me right back an angry message about the whole situation.
  • This was sort of my first experience of dealing with an unhappy member so I saw a glimpse of how reactive they can be, and it’s fair enough based on what they were going through. So I immediately understood where they were coming from, i’d be mad too if I kept getting told by these people to keep providing me doctor’s info just so I can pay my bills.
  • So I immediately notified the claims consultant and clarified that the next pads was not to be requested until further into the future. After that chat I immediately went back to the customer, apologised profusely and provided them with the correct information and documented it on CARE.
  • There was a few things i learnt from this experience:
  • First thing is to always clarify if you’re unsure about any information. All CM’s have different styles so one’s work can at times not be as straightforward as another.
  • I do believe the most important thing you can do when you have made a mistake, obviously after you’ve mitigated it, is to learn from it. So I made sure to document this information in my own notes, and at the times they did not have those letter templates but I realised that my wording can be much more accommodating and polite to the member. So I included lines such as letting us know if you have any trouble in attaining the documents so that we can work together through it and come up with an ideal arrangement for them.
    What you can see from this anecdote is that when I made a mistake and someone is unhappy about it always focus on the customer’s point of view and why they are getting angry, even though it can be difficult this is really important. Because if you think with empathy you’ll always be orientated towards a solution over everything else and prevention for the future. This is the type of approach I take with my current members that I manage and is what I would continue to do for each member if I were to get this role and potentially take on that full load of claims.

Question 9

Why don’t you tell us about the journey you’ve gone through to get you where you are now.
What about your training? How has it gone?
How will you bridge that gap from your role as an admin to a claims consultant?

Answer 9

• It’s been a really great experience.
  
  • Starting out in the admin role was really great for me.
  • I believe that it was a great starting place to get exposure to the world of claims, the different business processes that go around in a day to day operation. It really allowed me to familiarise and get a good understanding of the admin side of claims.
  • The experience really helped me take my organisation skills to another level. There’s alot of different admin processes that I had to learn whether it be paying invoices or those external file sharepoints, I developed a really great system for me to refer to which was using one note where I recorded all the new processes that I did to go back to for reference. It’s also where I saved all my important links, templates for letters, QRG references and i’ve built it up over my time as an admin. On top of that the admin role has helped in the juggling of different items and understanding how to prioritise and organise my day and workload over a week.
    In this role I was also able to work in the two teams and provide assistance to the claims consultants across the two teams allowing me to develop really good relationships.
  • My training experiences these last few months have been fantastic. It really opened up a whole new side of the business as admin was only ever surface level. The induction training gave a really great theory understanding of everything and kind of put a frame work together in my mind the life of a claim in insurance and all the different tools and skills the cms use.
  • But what really helped things settle in was the shadowing sessions and the start on my own portfolio.
  • I was fortunate to be able to train with some really great and experienced claims consultants who showed me their ways, and how to approach each claim, and the thought process that they go through at each step. In our sessions I was able to complete assessments under their supervision which really helped me to get feed back right away. This helped put together all the theory I’d covered, i’m an application based learner and really need to do something to get my head around it so this was really great for me.
    Taking on my own portfolio provided that element of autonomty and independence and further strengthened the process and my experience as a claims consultant.
  • I think that my experience and training so far has really built a great foundation as a claims consultant.
  • I have learnt alot of the skills that are needed for the role, the main focus is going to be the volume and learning how to manage through 120+ claims.
  • But I beleive this is something that I am more than prepared for, I believe that my organisation skills and hard work will really help me to take that next step forward.
  • And one more thing to mention again is I’ve had the fortunate opportunity of being apart of the team, building those relationships with people who I’ve always done my best to provide any sort of assistance that I could and who have done the same for me. I understand the standard that you’ve set and what you expect from the team and the culture that you’re trying to cultivate within m1 of getting it done. So I really do believe I could make that next step to transition into this role.

Question 10

Do you have any questions for us?

Answer 10

• In terms of things like CDC referrals, CDAP, legal, CMO opinions, do you expect alot of these situations for this role?
  
  • Will this role still involve working with the rest of the LTC team? I know that Paul works quite closely with some of the others from the LTC team such as Maria, would I have to be apart of that?
    How would One pursue a DA?