MARY NGUYEN
Brisbane,Australia
Summary
Claims professional with over 8 years’ experience across Health, General Insurance, and Workers’ Compensation. Skilled in managing complex statutory claims end-to-end, including Permanent Impairment (PI) assessments, Independent Medical Examinations (IME), Medical Assessment Tribunals (MAT), and case conferences. Experienced in relationship management, advocacy, and ensuring fair claimant outcomes while maintaining compliance with legislation. Strong analytical, interpersonal, and communication skills with proven ability to handle sensitive matters with empathy and professionalism.
Overview
13
13
years of professional experience
Work History
Claims Advisor
WorkCover Queensland
01.2025 - Current
- Manage a diverse portfolio of statutory claims, including complex physical and psychological injuries
- Conduct detailed triage assessments of new claims, determining liability and appropriate claim pathways
- Coordinate and refer claimants to IME, MAT, and MAP, preparing comprehensive referral documentation and reviewing expert reports
- Facilitate and participate in case conferences with treating specialists, allied health providers, rehabilitation coordinators, employers, and legal representatives
- Manage the PI process, including issuing NOAs and RFDs in line with legislative and procedural requirements
- Utilise CPIS and other referral systems to record, monitor, and progress claims efficiently
- Draft and issue detailed correspondence to stakeholders outlining legislative decisions, medical findings, and claimant entitlements
- Build and maintain strong relationships with injured workers, employers, medical providers, and legal representatives
- Advocate for injured workers’ access to treatment, rehabilitation services, and return-to-work programs
- Manage disputes and escalations, preparing matters for potential review or appeal
- Demonstrate empathy, resilience, and interpersonal skills when managing highly sensitive and complex claims
Medical Claims Assessor
Bupa Health Insurance
07.2024 - 01.2025
- Managed high volumes of medical claims while maintaining compliance with billing guidelines
- Ensured accuracy and timeliness of payments by resolving discrepancies
- Collaborated with medical professionals to ensure fair claim outcomes
- Conducted audits and identified fraudulent claims, protecting scheme integrity
- Advocated for providers through appeals processes when warranted
Outbound Retention Specialist
Bupa Health Insurance
01.2024 - 07.2024
- Reduced customer discontinuance through proactive engagement
- Handled objections with empathy and resilience
- Applied private health insurance knowledge to cross-sell and upsell products
- Exceeded KPIs and NPS targets consistently
Senior Claims Manager (Personal Accident)
Catholic Church Insurance
07.2019 - 12.2023
- End-to-end management of complex Student Personal Accident claims
- Liaised with allied health professionals on treatment plans and accounts
- Managed reserves, timely assessments, and accurate settlements
- Issued correspondence to claimants outlining entitlements and claim decisions
- Ensured handling of claims in accordance with legislation and company policies
- Conducted investigations and liaised with brokers regarding coverage
- Trained junior staff in best practices and industry regulations
- Built and maintained relationships with stakeholders while managing sensitive claims
- Demonstrated empathy, accuracy, and professionalism throughout claim lifecycle
Claims Assessor
Bupa Health Insurance
06.2018 - 06.2019
- Assessed health insurance claims for eligibility and benefits
- Identified fraudulent claims and liaised with anti-fraud units
- Maintained detailed records and compliance with regulations
- Handled escalations regarding claim denials with professionalism
Outbound Retention Specialist
Bupa Health Insurance
01.2016 - 07.2018
- Customer-focused approach to reduce discontinuance
- Applied health insurance expertise to support members
- Exceeded retention and NPS targets
Business Account Manager
Telstra Business Centre
01.2013 - 12.2015
- Managed relationships with business clients
- Identified customer needs and tailored solutions
- Achieved sales and retention targets
- Built trust and rapport with clients across multiple industries
Education
Bachelor - Speech Pathology
The University of Queensland
High School Diploma - undefined
Forest Lake State High School
Diploma - Clinical Coding
HIMAA
07-2026
Skills
- Strong knowledge of Workers’ Compensation, Health Insurance, and DVA-style claims frameworks
- High attention to detail, accuracy and adherence to procedures
- Experienced in CPIS, HAMBS, e5, Apollo, Cyclops and referral systems
- Strong written and verbal communication skills
- Relationship management with injured workers, employers, medical providers, and legal representatives
- Legislative compliance, decision writing (NOA & RFDs), and dispute resolution
- Ability to manage sensitive and complex claims with empathy
- Time management and ability to multi-task in high-volume environments
Accomplishments
- BUPA Global Awards Finalist - Top Retention Consultant AU & NZ (2018)
- BUPA Retention Consultant Q1 QLD and VIC (2017)
- BUPA Top Retention Consultant QLD & VIC (2016)
- Telstra Business Centre Top Account Manager (2015)
Timeline
Claims Advisor
WorkCover Queensland
01.2025 - Current
Medical Claims Assessor
Bupa Health Insurance
07.2024 - 01.2025
Outbound Retention Specialist
Bupa Health Insurance
01.2024 - 07.2024
Senior Claims Manager (Personal Accident)
Catholic Church Insurance
07.2019 - 12.2023
Claims Assessor
Bupa Health Insurance
06.2018 - 06.2019
Outbound Retention Specialist
Bupa Health Insurance
01.2016 - 07.2018
Business Account Manager
Telstra Business Centre
01.2013 - 12.2015
High School Diploma - undefined
Forest Lake State High School
Bachelor - Speech Pathology
The University of Queensland
Diploma - Clinical Coding
HIMAA