Eligibility Officer
Hybrid
Core
Assess and determine workplace injury claims of varying complexity, gathering information from workers, employers, and medical professionals to decide on claim acceptance or decline.
Role type
Claims adjudication officer
Builds
Workplace injury claim decisions and return-to-work outcomes
Domain
Insurance / Personal injury / Workers' compensation
Deliverable
client delivery
Required skills
Claims assessment, liability analysis, legislative application, evidence evaluation, stakeholder communication, decision-making
Responsibilities
Manage inbound and outbound calls to direct customer queries; Assess and determine workplace injury claims ensuring decisions are accurate and consistent; Assist workers and employers to navigate the claims process; Develop strategies to support key performance measures.