Job description
We are looking for an experienced and motivated Quality Assurance and Audit Officer to join our client in their CBD, Brisbane office. This is a hybrid role, 3 days in the office, 2 days from home.
This role will focus on both Quality Assurance and Claims Audit to ensure our claims processes, people and systems are continuously improved, compliant with regulatory standards and providing exceptional service. Reporting directly to the Technical Manager, this role will collaborate closely with key internal and external stakeholders.
Key Responsibilities:
Applicants new to DFP may be asked to provide additional information including work rights status via a survey link – if requested, we ask that you provide this information in order to expedite your application.
DFP welcomes applications from Aboriginal and Torres Strait Islander people, people with diverse cultural and linguistic backgrounds and people with disability. In addition, DFP will provide reasonable adjustments for individuals with disability throughout the recruitment process. If you identify as a person with disability and require adjustments to the application, recruitment, selection and/or assessment process, please advise via adjustments@dfp.com.au or 1300 337 000 and indicate your preferred method of communication (email, phone, text) so we can keep in touch and meet your accessibility needs.
By clicking 'apply', you give consent that DFP may use your personal information to process your job application and to contact you for future employment opportunities. For further information on how DFP process your personal information please review the DFP Information Collection and Privacy Policy via https://www.dfp.com.au/about-us/policies. Do not submit any sensitive personal information in your resume.
This role will focus on both Quality Assurance and Claims Audit to ensure our claims processes, people and systems are continuously improved, compliant with regulatory standards and providing exceptional service. Reporting directly to the Technical Manager, this role will collaborate closely with key internal and external stakeholders.
Key Responsibilities:
- Review the claims process, including phone calls, claims outcomes, and communications, to identify deficiencies and recommend improvements, especially within the quality function.
- Analyse customer experience and satisfaction with claims management, using customer feedback to drive outcome improvements.
- Ensure product integrity by regularly reviewing and maintaining standards.
- Identify gaps in process, service, or knowledge and collaborate with relevant stakeholders to implement improvements.
- Measure and review claims performance against KPIs, working to improve individual and team results.
- Coordinate and facilitate quarterly Underwriter QA reviews and report findings to internal stakeholders.
- Lead QA calibration sessions with internal claims leaders to ensure consistency in quality assessments.
- Review live claims payments to identify "live" leakage, potential leakage, incorrect or duplicate payments, and ensure compliance with payment limits, authority levels, and policy coverage.
- Reduce claims payment errors by working closely with claims officers to address any identified issues.
- Ensure that all claims decisions are well-documented and supported by policy guidelines and underwriter advice.
- Ensure all claims, fraud, quality, and investigation processes comply with industry regulations, including ASIC, GICOP, and AFCA standards.
- Identify and assess risks associated with fraud, payment inaccuracies, and procedural gaps, implementing risk mitigation strategies.
- Support the anti-fraud framework, detecting and preventing fraudulent activity and ensuring adherence to preventative measures.
- Foster a culture of compliance and integrity, ensuring team members understand and follow legal and regulatory requirements.
- Assist in the handling and reporting of compliance incidents, ensuring timely resolution and accurate documentation.
- Design and produce monthly performance reports based on agreed metrics (both qualitative and quantitative).
- Contribute to the weekly and monthly audit reports, ensuring accuracy and completeness.
- Minimum of 5 years in insurance claims processing, with a strong understanding of claims handling, fraud prevention, and regulatory requirements.
- Experience in claims processes, fraud detection and payment systems
- Strong understanding of industry regulations and a commitment to ensuring compliance within claims operations
- Stakeholder engagement
Applicants new to DFP may be asked to provide additional information including work rights status via a survey link – if requested, we ask that you provide this information in order to expedite your application.
DFP welcomes applications from Aboriginal and Torres Strait Islander people, people with diverse cultural and linguistic backgrounds and people with disability. In addition, DFP will provide reasonable adjustments for individuals with disability throughout the recruitment process. If you identify as a person with disability and require adjustments to the application, recruitment, selection and/or assessment process, please advise via adjustments@dfp.com.au or 1300 337 000 and indicate your preferred method of communication (email, phone, text) so we can keep in touch and meet your accessibility needs.
By clicking 'apply', you give consent that DFP may use your personal information to process your job application and to contact you for future employment opportunities. For further information on how DFP process your personal information please review the DFP Information Collection and Privacy Policy via https://www.dfp.com.au/about-us/policies. Do not submit any sensitive personal information in your resume.
