Job No:
ROLE PROFILE
Job Title: Dental Claims Adviser (DCA)
Department:
Division
Current Job Holder(s):
Claims Delivery – Operations Date Created/By:
DEPARTMENT DESCRIPTION
The MPS claims handling process is designed to ensure efficient and timely claims handling, providing
excellent service to members. All new claims and pre-claims undergo assessment and evaluation
within the Claims Assessment Team (CAT) prior to allocation for handling by the appropriate Medical
or Dental Pathway Teams.
The Claims Delivery department is part of the Operations division. The department comprises multidisciplinary teams with the right level and balance of claims handling, clinical input, professional and
administrative support resources, required to deliver a world class claims management service to
MPS/Dental Protection members.
JOB PURPOSE
The Dental Claims Adviser will work as part of a collaborative co-located team including claims
managers, litigation solicitors, quantum and costs advisers, claims assistants and support staff. The
DCA will provide clinical input during team reviews of cases, proofing witnesses, instruction of experts
and review of expert reports, meeting with Counsel, experts and members as well as playing a key role
in supporting the member through the life of the claim.
RESOURCES MANAGEMENT
Management responsibility for: N/A
Reports to: Service Delivery Manager
Budgetary/financial framework: N/A
KEY RESPONSIBILITIES
1.
Where necessary during the life of a case, review data provided by members to determine ongoing member indemnity cover at POI and undertake the authority to assist decision liaising
with membership and risk departments where appropriate
2.
Provide clinical input to the handling team at key stages through the claim including initial file
review, proofing witnesses, instruction of experts, meeting with Counsel and attending trial.
3.
Correspond with members in response to queries and in relation to strategy decisions on
cases.
4.
Provide support for other members of the team and organisation as a whole.
1
Job No:
ROLE PROFILE
5.
Keep up to date with current clinical practice, regulations, standards and law and be aware of
and comply with professional ethical obligations and all internal rules, policy and procedures.
Meet all applicable CPD requirements.
6.
Work to develop claims handling expertise, both individually and for the division as a whole.
7.
Comply with all relevant internal and external rules, policy and procedures, including those
relating to Health and Safety, Data Protection, IT Security and all those contained within the
issued Staff Handbook. Adhere to the business rules relevant to the role, which are subject
to change from time to time.
8.
Deliver team and individual targets to ensure they are consistently met and exceeded in
accordance with MPS Delivering Exceptional Staff (DES).
MAIN JOB REQUIREMENTS AND PERSON SPECIFICATION
Education/Qualifications/Training:
Graduate (and preferably postgraduate) dental degree and full registration with the General Dental
Council.
Legal qualification desirable (N.B. role holder will have claims legal support from claims managers and
litigation solicitors)
Specific Experience Required:
The post-holder should have postgraduate experience in clinical practice, an understanding of the
principles of clinical negligence and an understanding of the claims environment.
Abilities/Skills/Knowledge:







Excellent analytical, communication, interpersonal and negotiation skills
Articulate and persuasive
Ability to remain calm and professional in the face of challenge and assertion
Ability to resolve conflict in an effective and professional manner
Strong commitment to a collaborative working environment.
Ability to adapt and be flexible in order to meet the needs of the members and the team
Integrity and respect for people of all roles and backgrounds with the ability to gain the trust
and respect of colleagues and external contacts
Highly motivated and resilient
Good time management
Pro-active approach
Ability to handle sensitive/confidential issues appropriately
An ability to apply the knowledge he or she has gained through clinical experience for the
purpose of decision making and member management as part of the claims handling team
Awareness of when to escalate for further guidance
IT literate with practical experience of using IT as an analytical and case management tool.







2
Job No:
ROLE PROFILE
I confirm that this is a true and accurate reflection of this job
JOB HOLDER signature:
Print Name:
Date:
LINE MANAGER/SUPERVISOR signature:
Print Name:
Date:
HEAD OF DEPARTMENT (if different from Line Manager above) signature:
Print Name:
Date:
3