Claims Case Manager

MetLife Insurance; Sydney; On-site; AUD 90,000 - 120,000; Full time

Benefits offered by this job

Life insurance benefits

Parental leave

Menopause & fertility leave

Car leasing

Employee Assistance Program (EAP)

Job summary

MetLife Australia is seeking experienced Case Managers to oversee a portfolio of complex life insurance claims, primarily across Group with Retail experience valued. You will assess claims in line with policy intent, using digital tools, while supporting customers through critical life moments with empathy and professionalism.

You will deliver end-to-end claims management, maintain DA accreditation, and collaborate with stakeholders to improve processes and customer outcomes in a dynamic,

Qualifications

• Experience managing life insurance claims, ideally within a Group Insurance environment (TPD, IP, Death).
• Currently holds a DA across all Group product lines or can prove current DA held.
• Solid understanding of relevant legislation, policy definitions, and the claims assessment process.
• Proven ability to interpret complex information and make defensible, evidence-based decisions.
• Strong communication skills with the ability to explain outcomes clearly and support customers with empathy.

Responsibilities

• End-to-end management of life insurance claims (TPD, IP and Death) ensuring assessments align with policy terms and risk frameworks.
• Utilise claims platform and digital tools to support high-quality, efficient assessments.
• Communicate decisions clearly with empathy and professionalism to claimants and advisers.
• Maintain active DA and ensure compliance with regulatory requirements and SLAs.
• Collaborate with internal and external stakeholders to support customer-first outcomes and continuous improvement.

Skills

Life insurance claims

Group Insurance

DA accreditation

Policy interpretation

Communication skills

Digital systems

Team player

Resilience

Education

Tertiary qualifications (desirable)

Job description

We’re looking for experienced and motivated Case Managers to join us at a pivotal time in our digital transformation journey. In this role, you’ll manage a portfolio of complex life insurance claims – primarily across Group but Retail experience is also highly valued. You’ll be empowered to use your technical skills to assess claims in line with policy intent, while supporting customers through critical life moments with empathy and professionalism. This is a great opportunity to be a part of a team that’s modernising the way we deliver claims, placing customer outcomes, efficiency and integrity at the centre of everything we do.

Technical expertise:

Proactively manage and assess a portfolio of claims end to end, develop, recommend and implement case management strategies to drive sustainable outcomes and consumer expectations adhering to the policy definitions, philosophies, risk management meeting SLAs and other core claims metrics (includes claims handling requirements around claim strategy, financial, medical and eligibility assessments). With a strong digital focus, you’ll use our claims platform and tools to support high-quality, efficient assessments.

Customer experience and communication:

Proven ability to communicate professionally claims decisions and updates written and verbal (include strong telephony standards). Deliver a consistently high standard of service by communicating with empathy, clarity, and professionalism. You’ll provide timely updates, transparent decisions, and personalised support, ensuring members feel informed and cared for throughout their claims journey. Your communication style will support our customer-first values while meeting both compliance and service expectations.

Delegation of Authority (DA):

Currently holds a DA with consistent pass QA outcomes in their portfolio

Risk management:

drives and adheres to all claims related regulatory and compliance requirements eg LICOP timeframes and set MetLife SLA decision timeframes. Recognise, categorise and prioritise claims in accordance with business needs and Fund partner expectations

Collaboration/culture:

Work collaboratively with all stakeholders (internal and external) to establish and maintain relationships with Claimants, Financial Advisers, Distribution as applicable as well as drive an inclusive workplace culture (strong team player)

Time management:

proven time management skillswith demonstrated ability to prioritise work in a changing environment

Continuous improvement:

Identify opportunities to improve how we assess and manage claims, whether through streamlining processes, clarifying communications, or leveraging system capabilities. You’ll work with your leader to share these ideas, contributing to our broader goal of enhancing both the customer and case manager experience.

Complaints:

Respond and manage escalations and complaints relevant to the team’s portfolio

Qualifications and Experience:

Experience managing life insurance claims, ideally with 3+ years’ experience within a Group Insurance environment (TPD, IP, Death).

Work with minimal supervision and currently holds a DA across all Group product lines (can prove current DA held).

Sound understanding of relevant legislation, policy definitions, and the claims assessment process.

Proven ability to interpret complex information and make evidence-based, defensible decisions.

Strong communication skills, with the ability to explain outcomes clearly and support customers with empathy.

Comfortable working with digital systems and open to adapting to new technology and ways of working.

A collaborative team player who contributes positively to team culture and supports shared goals

Demonstrated resilience and adaptability when managing complex cases, competing priorities , and change.

Tertiary qualifications in a relevant field (e.g., allied health, legal, business, insurance) are desirable but not essential.

To Be Successful You Will Deliver:

End to end management of life insurance claims (TPD, IP and Death), ensuring assessments align with policy terms, claims philosophy and risk frameworks.

Completion of MetLife Claims Accreditation Program to attain DA within 3 months of employment commencement with MetLife.

Quality decisions supported by sound analysis of medical, vocational, and financial information.

Customer-first outcomes by balancing empathy, compliance, and commercial considerations.

Strong adherence to service level agreements (SLAs), quality standards, and customer satisfaction (CSAT) measures.

Effective written and verbal communication that clearly outlines the decision rationale and next steps.

Positive engagement with internal and external stakeholders, including medical providers, trustees, and reinsurers.

Active contribution to a team environment that values professionalism, accountability, and continuous improvement.

Benefits We Offer

When you join MetLife Australia, you are joining a company that demonstrates holistic care and wellbeing for employees with benefits and programs that address physical, mental, social and financial health.We offer life insurance benefits, generous paid parental leave, market leading menopause and fertility leave, car leasing and more. As well as Employee Assistance Program (EAP), access to 360Health medical support, volunteer leave and study assistance.

About MetLife

Recognised onFortune magazine's list of the 2024 "World's Most Admired Companies", Fortune World’s 25 Best Workplaces for 2024, as well as the Diversity Council of Australia Inclusive Employer Award 2023-2024, MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies: providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.

Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by empathy, we’re inspired to transform the next century in financial services.

At MetLife, it’s#AllTogetherPossible. Join us!