Senior Claims Case Manager - HSECi

MetLife Insurance; Melbourne; On-site; AUD 90,000 - 130,000; Full time

Job summary

MetLife Insurance in Melbourne is seeking an experienced Senior Case Manager to own a portfolio of complex Group Life Insurance claims, focusing on policy definitions, risk management and customer outcomes. You will lead change, coach peers, and embed a customer-first culture in a digitally evolving claims environment.

You’ll balance empathy with commercial outcomes, ensure SLA and CSAT targets are met, and collaborate with advisers, trustees and providers to drive continuous improvement and

Qualifications

• Extensive experience (5+ years) managing complex Group Life Insurance claims.
• Strong knowledge of policy definitions, trust deed requirements, and rehab strategies.
• Ability to interpret policy and legislative frameworks while balancing outcomes.
• Experience aligning with SLAs, CSAT, and regulatory obligations.
• Excellent written and verbal communication skills.

Responsibilities

• Make timely, technically sound decisions on complex Group Life claims.
• Lead continuous improvement initiatives within a digital claims environment.
• Coach and mentor junior case managers.
• Collaborate with trustees, advisers, and providers.
• Embed customer-first thinking across operating model.

Skills

Claims management

Stakeholder engagement

Coaching/mentoring

Regulatory compliance

Policy interpretation

Education

Tertiary qualifications in insurance or related field

Tools

Claims platforms

Analytics tools

Job description

We are looking for experienced and driven Senior Case Managers to join us at an exciting time in our digital transformation journey. In this role, you’ll take ownership of a portfolio of complex claims across all benefit types – with a focus on Group Insurance but open to Retail experience – ensuring decisions align with policy intent, our claim philosophy and risk frameworks. You’ll be empowered to exercise sound judgement while delivering SLA’s and CSAT metrics, all within a supportive team culture that values innovation and continuous improvement. This is a unique opportunity to contribute to shaping the future of claims management, where your expertise will help redefine how we support our customers in an increasingly digital world.

As a Senior Case Manager, you will do more than manage claims – you’ll help lead change. We’re seeking someone with strong technical skills who is eager to challenge the status quo and influence how we assess and progress claims. You’ll play a key role in embedding customer-first thinking into our evolving operating model, balancing empathy, efficiency, and compliance. Your insights and experience will directly inform us how we adapt our processes and technology to meet both customer expectations and our community and regulatory obligations.

Technical expertise:

Proactively manage and assess a complex 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. You’ll also embrace our evolving digital environment, using technology and data-driven insights to enhance assessment quality and efficiency. Your expertise will support capability uplift across the team through your strong coaching skills to develop other case managers’ capability in claims handling (financial, medical, eligibility assessments as well as proactive case management strategies) through knowledge sharing and mentoring.

Customer experience and communication:

Deliver a customer-first experience by communicating with empathy, clarity, and professionalism across all touchpoints. You’ll tailor your approach to meet the diverse needs of our members and stakeholders, ensuring they feel heard, informed and supported throughout the claims journey. With a strong focus on transparent, timely updates and clear written decisions, you’ll contribute to positive customer outcomes while upholding our brand promise. Your ability to balance compassion with commerciality will be key to maintaining service excellence in a digitally enabled, fast-paced environment.

Delegation of Authority (DA):

Holds a mid to high DA at current role consistently passing claim QA reviews of their assigned portfolio/peer reviews

Risk management:

Drives and adheres to all claims related regulatory and compliance requirements e.g. 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 ability to drive inclusive team culture (strong team player)

Time management:

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

Mentor/coaching:

Mentor and support Case Managers by sharing technical expertise and fostering critical thinking, while also identifying process or experience improvement opportunities and constructively discussing these with your leader to help them uplift team capability and drive better outcomes

Continuous improvement:

Identify opportunities for improvement in claims processes, decision making and customer experience, and proactively engage with your leader to shape and implement enhancements that support a more digital, customer-first, and compliant approach.

Complaints:

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

Qualifications and Experience:

• Extensive experience (ideally 5+ years) managing complex Group Life Insurance claims across a range of benefit types, including TPD, IP and Death.
• Strong working knowledge of policy definitions, trust deed requirements, superannuation legislation, and rehabilitation and return to work strategies within a Group Insurance context.
• Proven ability to interpret and apply policy and legislative frameworks while balancing commercial, regulatory and customer outcomes.
• Demonstrated capability to manage claims end to end with sound risk assessment, medical and vocational reasoning and stakeholder engagement.
• Experience working in alignment with service level agreements (SLAs), quality metrics, and customer satisfaction (CSAT) expectations.
• Strong written and verbal communication skills, including preparing clear and defensible claim decisions and reports.
• Comfortable working in an evolving digital environment, with experience using claims platforms and openness to leveraging technology to improve outcomes.
• A collaborative mindset with a passion for mentoring peers, sharing insights, and driving continuous improvement.
• Tertiary qualifications in a relevant field such as allied health, legal, business, or insurance (desirable but not essential)

To Be Successful You Will Deliver:

• Timely and technically sound decisions on complex Group Life claims (TPD, IP and Death), aligned with policy definitions, legislation, and our claim’s philosophy.
• Completion of MetLife Claims Accreditation Program to attain a mid-level DA within 3 months of employment commencement with MetLife.
• Strong case ownership, managing claims end to end while balancing risk, empathy and commercial outcomes.
• High levels of customer satisfaction and compliance by consistently meeting SLA’s, CSAT targets and regulatory obligations.
• Clear, well-reasoned written communications and defensible claims decisions that stand up to internal and external review.
• Constructive collaboration with internal and external stakeholders, including trustees, reinsurers, medical providers, and legal partners.
• Mentorship and support to peers and case managers, contributing to team capacity uplift and knowledge sharing.
• Identification and escalation of improvement opportunities, working with your leader to help shape and enhance our approach to our claims in a digitally evolving environment.
• Active contribution to a culture that values innovation, continuous improvement a customer-first mindset

About MetLife

Recognised on Fortune magazine's list of the "World's Most Admired Companies", Fortune World’s 25 Best Workplaces, as well as the Diversity Council of Australia Inclusive Employer Award, 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.

As part of our New Frontier strategy, MetLife is building an AI-enabled, people-centered future. We’re looking for people who bring curiosity, adaptability, and a growth mindset as we use AI to enhance how we serve customers, support communities, and evolve the way work gets done. At MetLife, AI is a responsible partner that supports human judgment, creativity, and continuous improvement while helping us build trust, inclusion, and long-term value.

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 our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we’re inspired to transform the next century in financial services. At MetLife, it’s #AllTogetherPossible. Join us!