Medical Claims Manager jobs

Bradley David Associates is currently looking for Senior Claims Technical and Quality Manager. This is to join a succesful financial services business.

• Monday to Friday 9am-5pm, hybrid
• City of Bristol modern office
• £50,000 - £65,000 dependent on experience
• Strong bonus
• Car allowance
• Amazing perks, benefits and pensions

Job Summary:

• Ensure a consistent, accurate, and high-quality claims assessment philosophy is established, maintained, and applied across all claims management teams and protection-related products.
• Drive technical excellence and claims expertise to deliver a high-performing claims capability.
• Ensure appropriate legal, regulatory, compliance, and financial controls are embedded within processes to effectively manage and mitigate risk.
• Provide line management and leadership to a small team of senior claims management consultants.

Key Responsibilities:

• Manage a fair and informative claims quality sampling programme that:
• Regularly provides feedback to line managers on individual and process performance.
• Supports recommendations and approval of authority level changes.
• Monitors the effective application of policy terms and conditions.
• Promotes consistency in assessment outcomes across all assessors.
• Ensures processes are accurate, informative, and support the correct payment of valid claims in accordance with policy provisions.
• Lead and manage a small team of senior claims management consultants.
• Provide technical guidance on complex claims and approve high-value claims within delegated authority limits.
• Chair and oversee a robust calibration panel that meets regularly to ensure consistency, technical accuracy, and best practice in claims decision-making.
• Drive a continuous programme of technical training, coaching, and knowledge sharing to enhance capability and support continuous improvement.
• Engage regularly with reinsurers, medical professionals, and other relevant stakeholders to identify knowledge gaps and improve technical expertise.
• Ensure all team activities comply with risk, compliance, and legal requirements, maintaining clear audit trails and high standards of integrity.
• Handle sensitive personal information in accordance with company policies and applicable data protection requirements, ensuring appropriate controls are maintained when managing medical and other confidential information.

Candidate Knowledge:

• Strong knowledge of protection products and policy conditions.
• Extensive claims management knowledge.
• Understanding of risk management principles and controls within a claims environment.
• Good medical knowledge and its application to protection products and claims assessment.
• Knowledge of the insurance and financial services sector.
• Understanding of data protection requirements and the handling of sensitive personal information.

Skills:

• Strong analytical skills with excellent attention to detail, enabling accurate interpretation of complex policy terms.
• Excellent verbal communication skills, with the ability to clearly explain technical concepts and processes.
• Strong listening skills, ensuring concerns and areas of uncertainty are effectively addressed.
• High-quality written communication skills, producing clear and concise guidance and documentation.
• Ability to influence and persuade stakeholders, gaining understanding and buy-in for processes, controls, and decisions.

Experience:

• Experience working within a protection claims or related claims environment.
• Managing complex claims, appeals, disputes, and escalated cases.
• Applying policy conditions and providing guidance or training to others on their application.
• Oversight of quality assurance programmes and key claims controls.
• Reviewing and interpreting medical information in relation to policy terms and conditions.
• Process governance, review, and sign-off responsibilities.
• Decision-making on high-value or complex claims.
• Managing claim declines and handling Ombudsman or dispute referrals.
• Presenting recommendations and improvement initiatives to senior management.
• Experience liaising with reinsurers and external stakeholders.
• Previous experience in a similar leadership or technical claims role is preferred.

If you are interested and have the relevant experience please apply to be contacted by a member of the team.

Pay: £50,000.00-£65,000.00 per year

Benefits:

• Additional leave
• Casual dress
• Company car
• Company events
• Company pension
• Cycle to work scheme
• Employee discount
• Flexitime
• Free or subsidised travel
• Health & wellbeing programme
• Life insurance
• Private dental insurance
• Private medical insurance
• Work from home

Application question(s):

• How many years of experience do you have handling Protection Insurance claims (Income Protection, Life Insurance, Critical Illness, or Group Protection)?
• Have you personally assessed and made decisions on complex or high-value protection insurance claims, including declined claims and appeals?

Work Location: Hybrid remote in Bristol Temple Meads Station