Job purpose: Clinical risk assessment of veterinary claims according to clinical appropriateness, policy terms and conditions. Assess invoices for appropriate billing. Provide support and education to claims staff. Maintain provider relations and negotiation of reasonable fees.

MINIMUM REQUIREMENTS:
• BVSC degree and/or Diploma as a Veterinary Nurse
• Excellent writing and interpersonal skills
• Ability to maintain provider relations
• Ability to function independently

KEY RESULT AREAS:
Clinical Risk Management
• Assessment of all veterinary claims for procedures and/or illnesses that require hospitalisation and/or high cost claims;
• Drafting formal correspondence for repudiated claims;
• Assist with training and mentoring of pet claim assessors;
• Liaison with veterinary service providers regarding information required to assess claims;
• Maintaining provider relationships and negotiation of fees;
• Assisting with Ombudsman queries and/or complaints;
• Functions as a subject matter expert in veterinary claims and advisor on product and process and identify trends, risks and fraud;
• Accountable for managing own time, tasks and output quality;
• Responsible for vet premium and claims performance and analysis reporting;
• Any additional responsibilities as required from time-to-time;
• Comply with company policy and procedures.