JESSICA SMITH
Brisbane,Australia
Summary
Proactive and empathetic Claims Specialist with 15+ years of experience managing complex injury and illness claims. Expert in interpreting policies and legislation to facilitate recovery and return-to-work outcomes, while ensuring compliance. A collaborative partner, skilled in building strong relationships with health providers and injured individuals, to drive understanding and continuous improvement. Passionate about making a positive difference in people's lives during difficult times.
Overview
17
17
years of professional experience
Work History
Principal Claims Manager
QSuper (ART Life)
Brisbane, Australia
10.2020 - 09.2024
- Pro-actively managed a portfolio of complex injury and illness claims, interpreting QLD-based legislative frameworks to ensure injured members received correct entitlements and were supported through recovery.
- Facilitated return-to-work plans by engaging injured members, employers, and a network of health providers including vocational rehabilitation providers and occupational therapists.
- Mentor others accurate policy interpretation to optimise good claim outcomes.
- Providing advice as required and check submissions for claims outside the delegation of the team members.
- Handling highly sensitive and complex issues that have been escalated.
- Contributing to a cohesive and supportive team environment.
- Spearheaded a new specialised claims team, developing all training and processes to ensure continuous improvement and exceptional service delivery.
- Held the highest delegated authority for this level for Income Protection, Total and Permanent and Terminal illness.
Senior/Claims Manager
QSuper (ART Life)
Brisbane, Australia
01.2017 - 09.2020
- Managed a diverse portfolio of income protection claims for physical and mental injuries, implementing proactive strategies to optimise member and organisational outcomes.
- Evaluating claim forms, medical, financial and investigative information to determine the appropriate claims management strategy.
- Providing efficient and effective assessment of claim management strategy for complex claims through the application of technical knowledge and skills.
- Accurately documenting, completing and validating claims ensuring that they are managed in accordance with claims strategy.
- Coordinated external service and health providers to gather information, arrange independent medical exams, and effectively manage each claim to facilitate recovery.
- Engaged injured members through open communication to understand the medical and personal dimensions of their illness or injury, ensuring they were aware of their rights and responsibilities.
- Identifying and managing systematic issues as they arise.
- Identifying any emerging trends that are impacting on claims. This could be internal process opportunities or risk, external market factors, new trends or techniques in managing claims or conditions.
- Held delegated authority for Income Protection and TPD claims.
Claims, Workshop, Health & Safety Manager
GO Rentals
Auckland, New Zealand
07.2015 - 12.2016
- Introduced Lean process by implementing the 5S concepts into our Mechanical Workshops.
- Decrease in job handling time by 39%.
- Created reports to ensure transparency in productivity within the workshops.
- Revolutionised the company's health & safety culture, implementing an automated system that increased audit compliance scores from 40/200 to 191/200.
- Set up a new panel beating division in one of our workshops to manage our long-term damaged vehicle repair process. This was introduced to reduce our external labour repair costs and make the vehicles more economical to repair.
- Created new process and procedures for major panel repairs to be compliant by law and ensure staff are working to vehicle repair specifications as per manufactures guidelines.
- Organised external training for our Mechanics upskill themselves in the latest machinery purchased and existing machinery for a certification.
- Upskilled existing staff to take on more complex claims and responsibilities within Claims and Workshop teams through succession planning.
- Created and negotiated supplier agreements with all Panel repairs and parts suppliers so that both parties had clear rules of engagement.
- Negotiated an additional 2% - 5% discount along with free delivery to all nationwide sites for our main vehicle parts suppliers.
National Business & Claims Manager
GO Rentals
Auckland, New Zealand
12.2011 - 07.2015
- Held operational responsibility for a national network, managing a team of 7 direct reports with 70+ indirect staff.
- Redesigned the company's rental terms and conditions to reduce ambiguity and minimise dispute risk.
- Centralised and transformed the claims function from a manual to a fully electronic claims management system, introducing in-house assessments and a preferred repairer network.
- Rolled out new system training to all staff across all 7 locations.
- Renegotiated the company's fleet insurance policy, securing an additional $5M in coverage with no premium increase.
- Recovered over $100,000 in previously un-pursued debt and maintained a 100% win rate representing the company at the Disputes Tribunal.
Customer Manager Team Leader
AA Insurance
Auckland, New Zealand
01.2008 - 12.2011
- Played a key leadership role in establishing a new Customer Service Centre, managing daily operations and technical escalations.
- Authored the department’s comprehensive training 'Bible,' which was adopted as the official audit tool.
- Managed a team of 12 members.
Education
Diploma of Financial Services - General Insurance
ANZIIF
Auckland, New ZealandCertificate of Financial Services - General Insurance
ANZIIF
Auckland, New ZealandSkills
- Injury and illness claim management
- Risk assessment
- Regulatory compliance
- Insurance regulations
- Proactive portfolio management
- Return-to-work facilitation
- Stakeholder engagement
- Difficult conversations
- Data analysis and reporting
- Empathetic communication
- Strategic thinking
- Continuous improvement
- Training and development
- Claims management
- Policy interpretation
- Claims strategy development
- Portfolio management
- Mentoring others
- Effective communication
Core Competencies
Injury & Illness Claims Management, Proactive Portfolio Management, Return-to-Work Facilitation, Recovery Coordination, Entitlements & Legislation, QLD Regulatory Frameworks, Injured Team Member Support, Health Provider Coordination, Vendor Management, Collaborative Partnership, Difficult Conversations, Claims Management Systems, Microsoft Office Suite, Data Analysis & Reporting, Policy Interpretation, Empathetic Communication, Strategic Thinking, Continuous Improvement, Training & Development
References
Provided upon request.
Timeline
Principal Claims Manager
QSuper (ART Life)
10.2020 - 09.2024
Senior/Claims Manager
QSuper (ART Life)
01.2017 - 09.2020
Claims, Workshop, Health & Safety Manager
GO Rentals
07.2015 - 12.2016
National Business & Claims Manager
GO Rentals
12.2011 - 07.2015
Customer Manager Team Leader
AA Insurance
01.2008 - 12.2011
Diploma of Financial Services - General Insurance
ANZIIF
Certificate of Financial Services - General Insurance
ANZIIF