Health Claims Specialist
4 days ago
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 is part of the Irish Life Group of companies. The Claims Operations function is looking for a motivated and driven Health Claim Specialist to join their team. This team member will be actively involved in the ICD (International Classification of Diseases) of health claims.
The successful applicant will be part of a driven team who ensure high quality standards are maintained at all times, working to achieve service and quality standards and striving towards the perfect customer experience.
The key responsibilities of the role will include- Review medical claims and assign appropriate ICD-10 codes in line with coding requirements.
- Ensure technical accuracy of coding completed in line with ICD-10 and responsible for timely quality data.
- Active involvement in the development of clinical coding team and attend any relevant training courses and system updates as required.
- Complete governance audits for all processed Hospital and Member Claims in line with our Quality Assurance Strategy.
- Liaise with relevant TPAs for overseas cases.
- Complete all local and overseas pre-approval in line with agreed procedures.
- Act as the first line of defence and identify any potential areas of inappropriate billing, fraud and abuse of the hospital and member claims process.
- Actively manage all team mailboxes in line with agreed KPIs.
- 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.
The successful person will hold an APA qualification (or higher) and will have 1-3 years' experience in health insurance claims assessment and ICD-10-AM clinical coding. 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- Preferable but not required, ICD-10-AM clinical coding 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.
- Excellent IT computer experience and of Microsoft Office.
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.
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.
If you require any accommodations during the recruitment process please contact lifecareers@irishlife.ie and we will be delighted to ensure you are fully supported to be your best.
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