Specialist Cover Assessor
Our vision is to create a unique partnership with every New Zealander,
improving their quality of life by minimising the incidence and impact of injury.
We know that a diverse and inclusive team helps us meet the needs of our customer, and we welcome candidates
from every ethnicity, national origin, gender identity, age, and those with a disability or who have additional mental
health needs. It is important to us that people are free to be themselves at work. Here are some ways we
encourage that:
• Employee networks to support our colleagues from diverse backgrounds.
• The option to explore flexible working that suits your needs and ours.
• Development opportunities in te reo Māori me ngā tikanga.
Position purpose
A Specialist Cover Assessor is responsible for using specialised clinical knowledge to assess clinical information to
make cover decisions on highly complex claims in accordance with relevant legislation and policies.
Key Accountabilities and Outcomes
•
Complete cover assessments on highly complex claims using your specialised clinical knowledge to make
timely cover decisions.
• Use your professional clinical knowledge to enable you to complete the initial classification, prioritisation and,
identification of needs and additional evidential information is required to make an assessment and cover
decision.
• Consider clinical evidence and opinions about causation and/or appropriateness of cover.
• Proactively engage with clients and providers to facilitate quicker decision making.
• Arrange any independent assessment required to inform cover decisions, engaging with customers,
employers, providers, internal advisors, medical specialists and independent assessors as required.
• Identify and escalate any issues where there is a belief of risk of harm to the public based on the clinical
information gathered to make a cover decision.
• Document reasoned opinions on causation, (appropriate treatments as required) and the appropriateness of
claim cover, within delegations.
• Contact customers to verbally explain decline decisions explaining the outcome in a simple and meaningful
way so that they have a clear understanding of the decision.
• Assist relevant parties to understand the clinical aspects of the reasons for a decision, and what options may
be available to them.
• Participate in complaint and resolution processes to ensure the effective management of client concerns.
• Assist in identifying fraud.
• Support the team by sharing information and resources and providing feedback in a positive manner.
• Work in a collaborative and cooperative way with colleagues so that there is seamless, integrated support
for customers at all points of their recovery.
• Understand the approach for preventing injuries and working with the tools we need to deliver and monitor
injury prevention outcomes.
• Assist in identifying opportunities for continuously improving processes and services.
• Focus on delivering quality customer service and be responsive to customer feedback to contribute to the
continual improvement of our customer experience.
• Respect and protect the privacy of customer information to maintain trust and confidence in ACC.
• Champion opportunities to embed Whāia te Tika to promote diversity and inclusion.
Experience and Qualifications
• Post-graduate clinical experience as a practitioner dealing with the public.
• Recognised clinical qualification in a relevant clinical field.
• Current annual practicing certificate.
• A comprehensive understanding of one or more health service categories.
• Good understanding of the health and rehabilitation sector.
• Comprehensive and up to date understanding of relevant clinical knowledge and conditions.
• Good judgement, decision-making and problem resolution skills.
• Clear and effective verbal and written communication
• Excellent customer service skills with the ability to deliver outcomes with empathy.
• Ability to review and understand legislation and organisational policies.
• Time management skills including the ability to meet deadlines, prioritise, and manage a high volume of
work
• Ability to operate effectively in a digital environment with a wide range of technology systems and tools.
ACC Behaviours
Accountable: He tangata pono
I make considered decisions; I’m responsible for my actions, and I take practical steps to overcome challenges.
Inclusive: He tangata kotahitanga
I encourage others; I respect different perspectives; I collaborate and make it easy for ideas to be shared.
Curious: He tangata mahira
I am open to new ideas; I welcome feedback and seek opportunities to improve.
Customer focused: He tangata aro kiritaki
I enable my customers to achieve the right outcomes by being responsive, clear and transparent.
