Health Claims Service Team Lead

6 days ago

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

Company: Irish Life Group Services Limited

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

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 Team Leader to join their team.

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

Reporting to the Health Claim Service Manager, the Health Claims Service ICD coding Team Lead will be responsible for the smooth running and overall effectiveness of a Claims Operations team.

What you will help us to achieve
  1. Focusing on delivering customer first solutions to maximise our customer experience.
  2. Day to day co-ordination of the team service levels and work load.
  3. Oversight of the service levels for our providers interaction activities (Voice & Email), all assigned claim productivity targets, ICD coding requirements to ensure KPIs are met.
  4. Ensuring all claim payments are made to the right payee, at the right time, with a focus on accuracy.
  5. Complete governance audits for all claims and verify all minimum audit levels are met in line with our Quality Assurance Strategy including ICD coding completed on claims.
  6. Ensure all governance requirements are adhered to and are fully auditable.
  7. 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.
  8. Actively manage all team mailboxes in line with agreed KPIs.
  9. 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.
  10. Assist in the production and delivery of training materials for our TPA partners and internal teams to ensure that the agreed processes and procedures are rolled out effectively in a controlled manner.
  11. Lead by example and uphold the standards of professionalism expected of the team.
  12. Build positive and proactive working relationships across the organisation as well as with our TPAs.
  13. Supporting the governance and oversight of ICD Coding.
  14. Requirement to complete Clinical Coding training as required.
What you will need to be successful in the role

The successful person must hold an APA qualification (or equivalent) and will ideally have 5 years' experience in the insurance industry.

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
  1. Clinical background to support on the development of the ICD coding internal team.
  2. Be a self-starter and willing to act on own initiative.
  3. Ability to develop and implement training plans and successful roll out to team members.
  4. Ability to manage a demanding workload while co-ordinating work effectively across the team.
  5. Ability to lead by example and drive standards of professionalism within team.
  6. Strong stakeholder management skills.
  7. Act as part of a team and give full participation and commitment to fellow team members to meet common goals.
  8. Ability to deputise and set up for Health Claims Service Manager.
  9. Experience in health insurance with an excellent knowledge of claims processes, assessment rules, policy terms and conditions is desirable.
  10. A good understanding of the principles of governance is desirable.
  11. Excellent communication and interpersonal skills.
Fitness & 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.

About us

Irish Life is one of Ireland's largest financial institutions with a presence across a range of financial services markets and 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 through Irish Life Health, their health insurance.

Irish Life Health provides Health Insurance to over 500,000 people across Ireland both directly and through Corporate schemes. Our Vision is to help people live healthier lives and we focus on providing access to healthcare solutions that will help our customers do this.

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.

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.

Irish Life Health supports Equal Opportunity and is regulated by the Central Bank of Ireland.

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