Alexis Andreu
Wakerley,QLD
Summary
Dedicated and experienced professional with a strong background in assessing group life claims, working with the Aged Care Quality and Safety Commission and more recently with the NDIS.
Possessing a comprehensive understanding of the regulations and processes involved in each area, I have successfully managed complex claims and ensured timely and accurate processing. I am skilled in conducting thorough investigations, communicating effectively with claimants and stakeholders, and providing compassionate support throughout the claims process. Proven ability to work efficiently under pressure and deliver high-quality results.
Proven track record in investigating and managing serious incidents in the aged care sector. Possessing a comprehensive understanding of regulatory requirements and best practices, I have successfully handled a wide range of complex cases and ensured compliance with all relevant policies and procedures. Skilled in conducting thorough investigations, analysing data, and implementing effective solutions to prevent future incidents.
Excellent communication and interpersonal skills, with a strong ability to liaise with stakeholders and provide support to affected individuals and their families.
Seeking a challenging role where I can utilise my expertise to improve the safety and quality of care for vulnerable people.
Overview
20
20
years of professional experience
Work History
Registration Officer – Provider Registration Regulatory Operations Division
NDIS Quality and Safeguards Commission
01.2024 - Current
- Registration of new applicants and renewing NDIS providers including suitability assessment Variations of registrations Application withdrawals and provider-initiated revocation of registration Mid-term audit assessment Triage of provider notifications of changes and events Provider and related stakeholder registration enquiries and information Internal liaison and strategy on compliance and enforcement COS registration module and data custodianship
Insurance Specialist
APEX Group
11.2022 - 11.2023
- Provide end-to-end insurance claims management and advice in the assessment of claims, whilst also contributing to the management and development of the Insurance team
- Manage day to day operations Provide leadership to team members Ensure all Service Standards pertaining to the Insurance area are met through effective management of resources and workflows - planning for known peaks and toughs, planning work rosters and annual leave accordingly Report Client Service Standard results monthly Provide the Insurance & Client Services Manager and General Manager with regular reporting on work status against objectives Drive continuous improvement initiatives Maintain Fund Business rules, ensure they are kept up to date and are signed off by agreed parties Ensure administration procedures and processes are reviewed on an annual basis
SIRS Assessor – Serious Incident Response Assessor
Aged Care Quality and Safety Commission
09.2021 - 10.2022
- Managing incoming reports and make triage assessment Liaison with providers by phone and email Referral of information to other areas within the Commission as required Conducting Risk-based assessments Managing sensitive and confronting information Provision of support to providers to understand new requirements as required Staff training and management (as required)
Biosecurity Assessment Officer
Department of Agriculture Water and Environment
07.2021 - 09.2021
- Undertake duties in line with the Biosecurity Act 2015 and decision support materials
- Extensive risk assessment- based duties Always maintain biosecurity and personal integrity Assessing documents for imported or exported commodities Inspecting people, goods, aircraft, and vessels to safeguard Australia’s biosecurity and export markets Managing items that don’t comply with our biosecurity legislation Representing us as a regulator, upholding and explaining policies to industry, travelers, or stakeholders Answering questions and providing advice about biosecurity risk items such as food, meat, and plant material
Claims Assessor
AIA
07.2020 - 07.2021
- Proactively manage my own portfolio of claims (between 80-130) that include Income Protection, Total and Permanent Disability, Terminal illness and Death claims
- Assess claims through the practical application of the policy terms and conditions, analysis of sensitive information such as medical, financial, and other relevant information, engaging the appropriate tools to ensure claims are appropriately managed in line with good claims management
- Confirm, and where appropriate, substantiate claims decisions to members, Trustees and/or Intermediaries as appropriate Investigate and resolve disputes pertaining to expectations of the client/advisor versus the reality of our product rules, policy terms and conditions and industry/business practice and our data and provide input of an expert nature to resolving escalated processes
- Engagement on a regular basis with all stakeholders involved
Enquiries Officer - Dispute Resolution Branch
Office of the Australian Information Commissioner
11.2019 - 07.2020
- Provide advice to the public by phone, in writing and face to face on the operation of the Privacy Act 1988 and the Freedom of information Act 1982 and other related legislation, including on legislative and jurisdictional issues, and make appropriate referrals to other government and industry bodies where necessary Under general direction, draft correspondence in relation to enquiries, complaints, and reviews Maintain descriptive and statistical records of enquiries for reporting purposes
- Provide administrative support to the wider office as required
Income Protection Case Manager
TAL
08.2019 - 11.2019
- Manage my own claims portfolio consisting of between 70-120 claims Analysis of sensitive and confidential information contained in medical reports, and clinical notes Liaise with doctors, solicitors, and claimants via different channels of communication Conduct initial and ongoing assessments Assessment of non-disclosure and financials for underwritten claims Prepare individual management plan for all claims and record actions as they occur Instruct third party service providers and monitor the service they provide
- Authorise payment of third-party accounts Calculate claim payments and obtain appropriate sign off in accordance with the delegation of authority Ensure claims are paid in accordance with service standards once all requirements are to hand Manage reinsurance referral and administration process
- Prepare file synopsis when required
Life Claims Case Manager
AMP
04.2019 - 08.2019
- Managing and improving the resolution of life claims within agreed authority structures, in accordance with client service standards, claims management and process requirements Knowledge of relevant legislation i.e., Privacy Act, Insurance contracts Act Understanding of insurance principles Perform admin functions as required Accurately pay claims as per policy terms and conditions Positively relay claims decisions to advisors/lawyers or clients, explaining assessment within the constraints of current legislation both through verbal and clear written communication Apply thorough non-disclosure investigations as required
Law Clerk
Maurice Blackburn Lawyers
11.2018 - 01.2019
- Day to day management and administration of superannuation and insurance claims
- Supporting the development of legal assistants within direct team and broadly across the department Meeting the prospective client/s and explaining the claim process Responding within relevant guidelines to queries from clients Managing client's expectations and clarifying instructions
- Building relationships with the Public Trustee of Queensland Crafting correspondence and legal documentation using precedents Co-ordinating claim documentation and liaising with super funds and/or insurers to obtain information relevant to the claim via phone, email, and formal letter correspondence
Insurance Administrator
IFAA
02.2015 - 11.2018
- Processing Insurance applications for Death/TPD cover and Income Protection Submitting underwriting applications to MLC for new insurance applications Maintaining an extensive Excel spreadsheet of on-going claims and important details pertaining to members enabling ease in tracking status and the ability to prioritise duties Report prepared using this data and presented to the board monthly Updating members with the progress of their insurance application, including communicating decisions of approvals and declines
- Regular follow ups requesting additional documentation required to support the client's claim Social Club Committee member for the third year – planning events
- Taking the lead on several events including sourcing catering options, Christmas party events and more Submitting Death/TPD and Extended Income Protection claims to the insurer Preparing submissions to the Trustee officer for Death and TPD (including payment recommendations) Communicating with third parties such as doctors and solicitors for claims updates
- Assessing insurance values for claim purposes Successfully transitioned insurance claims and underwriting data and files for a superannuation fund to a new administration company Initiated a fortnightly teleconference meeting between the Administration and Claims Teams
- The forward planning, that resulted from these meetings lead to more effective communication, the ability to prioritise and to a significant increase in productivity and a faster turnover of claims
Member Solutions Officer
QSuper
09.2011 - 08.2014
- Delivering personalised service via written and verbal communication Providing technical information to QSuper members and third parties who contact us via various channels of communication such as: email, fax, Facebook Acting as a first point of contact for email and general correspondence enquiries Providing written and verbal responses to claim enquiries and outcomes Liaising with claims department and insurance management team to obtain information on insurance enquiries Checking claims documentation as it comes in, to ensure all requirements have been met prior to being sent to our claims department Ensuring KYC (Know your customer) information has been obtained i.e., identification Providing general information and general advice insurance products such death and total and permanent disability (TPD) and income protection insurance Assisting members with quotes on insurances Relaying specific product information about our insurance policies, including exclusions to members Providing phone support to quotes team within Member support Quality check correspondence prior to being sent out to the relevant party Relief provided for the Senior Information Officer (SIO) hub Assisting the contact centre and providing telephone support Maintaining quality standards
Information Officer
QSuper
09.2010 - 09.2011
- Communicate effectively at all levels (including verbal and interpersonal skills) Modelling team commitments Maintaining the required technical knowledge proficiency to perform IO duties in an effective and timely manner by attending/participating in team meetings, Business unit meetings, TAU training sessions, CPD points, corporate information sessions and other identified mechanisms for personal growth Providing insight and expertise around the needs of the QSuper membership base and apply this to understanding and problem resolution and service response Proactively capture feedback/data obtained through general member queries via member contact Demonstrating a high level of problem-solving ability through strong knowledge and understanding of QSuper products, the superannuation or related industries, and relevant legislation to identify, research and understand complex business situations and recommend appropriate solutions where required
Assistant Branch Manager
Credit Union Australia
01.2005 - 01.2009
- Inbound and outbound calls Supervision of staff Training new staff Customer complaints and dispute resolution Compliance with privacy act and other regulations Achieving numerous sales targets (KPI’s) Technical support for staff
Education
04.2024
Ipswich Girls Grammar School
12.2002
Skills
Interpersonal skills - stakeholder engagement, building relationships
Communications skills - being clear and effective is vital
Problem solving skills - critical thinking
Analytical skills - identify patterns, draw conclusions
Timeline
Registration Officer – Provider Registration Regulatory Operations Division
NDIS Quality and Safeguards Commission
01.2024 - Current
Insurance Specialist
APEX Group
11.2022 - 11.2023
SIRS Assessor – Serious Incident Response Assessor
Aged Care Quality and Safety Commission
09.2021 - 10.2022
Biosecurity Assessment Officer
Department of Agriculture Water and Environment
07.2021 - 09.2021
Claims Assessor
AIA
07.2020 - 07.2021
Enquiries Officer - Dispute Resolution Branch
Office of the Australian Information Commissioner
11.2019 - 07.2020
Income Protection Case Manager
TAL
08.2019 - 11.2019
Life Claims Case Manager
AMP
04.2019 - 08.2019
Law Clerk
Maurice Blackburn Lawyers
11.2018 - 01.2019
Insurance Administrator
IFAA
02.2015 - 11.2018
Member Solutions Officer
QSuper
09.2011 - 08.2014
Information Officer
QSuper
09.2010 - 09.2011
Assistant Branch Manager
Credit Union Australia
01.2005 - 01.2009
Ipswich Girls Grammar School
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