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Specialist - Claims/Underwriting

4 months ago

Dublin, Dublin City, Ireland Irish Life Group Services Limited Full time

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Company: Irish Life Group Services Limited

  • Full Time Permanent position
  • Hybrid role based in our City Centre offices

What we offer
We have embraced a hybrid working model for most of our positions, which means that you can enjoy a balanced approach of working from home for part of the week and working from the office for the remainder of the week.

We offer a comprehensive benefits package including competitive salaries and bonuses, robust Learning and Development support, excellent Defined Contribution pension and comprehensive Wellbeing initiatives and support to name but a few.

Irish Life Health was created in August 2016 by the combination of Aviva Health and GloHealth. The company is part of the Irish Life Group of companies.

The Claims Operations function is looking for three new team members who are driven and ambitious and looking to progress their careers.

The successful applicant will be part of a driven team who ensure high quality standards are always maintained, working to achieve service and quality standards and striving towards the perfect customer experience.

This is an ideal opportunity to move into an exciting and challenging role and to develop a career within a very successful and ambitious company. This is a Minimum Competency role covered under the terms of the Central Bank requirements.

The key responsibilities of the role will include:
  • Complete governance audits for all processed Hospital and Member Claims in line with our Quality Assurance Strategy as required.
  • Liaise with relevant TPAs for overseas cases as required
  • Complete all local and overseas pre approval in line with agreed procedures
  • Manage audit process in line with QA strategy
  • Ensure all governance requirements are adhered to and are fully auditable
  • Act as the first line of defence, identify and manage any potential areas of inappropriate billing, fraud and abuse of the hospital and member claims process.
  • Manage Third Party claims and rebates in line with process
  • Actively manage all team mailboxes in line with agreed KPIs
  • Support the provider support mailbox and voice team
  • Identify and report on any ineffective or inefficient controls or claims processes, and provide inputs and recommendations into the correction of issues identified to Senior Management
  • Assist in the production and delivery of training materials for our TPA partners to ensure that the agreed processes and procedures are rolled out effectively in a controlled manner
  • Flexibility to support all aspects of the operation
The Person:

The successful person will hold an APA qualification (or higher) and will ideally have 3 years' experience in claims processing within Health Insurance. This role is subject to F&P.

The individual selected will be customer focused and be motivated to make a difference and play a very significant part in the delivery of our business objectives.

Skills & Experience
  • Have proven experience in health insurance with a good knowledge of claims processes, assessment rules, policy terms and conditions
  • Claims audit experience and a good understanding of the principles of governance is desirable
  • Excellent knowledge of health insurance plans and relevant legislation.
  • Excellent communication and interpersonal skills
  • Be a self-starter and willing to act on own initiative
  • Managing a demanding workload with an ability to prioritise effectively
  • Act as part of a team and give full participation and commitment to fellow team members to meet common goals
  • Good system knowledge and use of Microsoft Office
Planning and Organising

Delivering Superior Customer Satisfaction

Team Working & Cross Functional Collaboration

Risk and Control

Fitness and Probity

This role is a 'controlled function' as defined by the Central Bank Reform Act 2010 Regulations 2011. Any appointment will be conditional on the company being satisfied that the appointee meets the requirements as set out in the Fitness and Probity standards issued by the Central Bank. This requires the company to complete prescribed due diligence to assess the appointee's fitness and probity. Further details on this due diligence process are available from ILIM Human Resources.

About us

Irish Life is one of Ireland's largest financial institutions with a presence across a range of financial services markets. We are one of Ireland's leading financial services groups with over 1.5 million customers. For over 80 years, we've been helping people to look after their life insurance, pension and investment needs, and more recently their health insurance.

It is a subsidiary of Great-West Lifeco and a member of the Power Financial Corporation group of companies.

We are proud of our culture of developing and supporting the growth and professional development of our people. The focus has resulted in a team of top talent with high standards, positioning us at the forefront of our industry.

The company reserves the right to draw up a shortlist as part of the selection process. Where Agency assistance is required the Irish Life Recruitment Team will engage directly with suppliers. Unsolicited CVs / profiles supplied to Irish Life by Recruitment Agencies will not be accepted for this role.

Irish Life is proud to be an Equal Opportunities employer. We have created an environment of inclusion and growth to help people achieve their potential, to ensure they can bring their whole selves to work and to feel valued. We celebrate diversity of thought and perspective and want all of our employees to feel valued, respected and supported.

We have built a culture that promotes equality and inclusion for all of our current and future employees and strive to ensure that our behaviours, processes and practices are aligned to this culture.

If you require any accommodations during the recruitment process please contact and we will be delighted to ensure you are fully supported to be your best.

ILFS supports Equal Opportunity and is regulated by the Central Bank of Ireland.

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