Health Claims Operations Team Lead

3 days ago


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

About Us
Irish Life Group Services Limited is a leading provider of health insurance solutions in Ireland. Our team is dedicated to delivering high-quality services to our customers, and we are seeking an experienced professional to join our Health Claims Operations team.

Role Overview
The successful candidate will be responsible for the smooth running and overall effectiveness of the Health Claims Operations team. This will involve ensuring high-quality standards are maintained at all times, working to achieve service and quality standards, and striving towards the perfect customer experience.

Main Responsibilities
- Deliver customer-first solutions to maximise customer experience
- Co-ordinate day-to-day activities of the team to ensure service levels are met
- Oversight of service levels for providers' interaction activities, assigned claim productivity targets, ICD coding requirements to ensure KPIs are met
- Ensure accurate payment of claims to the right payee at the right time
- Complete governance audits for all claims and verify minimum audit levels are met in line with our Quality Assurance Strategy
- Ensure adherence to governance requirements and maintain auditable records
- Identify potential areas of inappropriate billing, fraud, and abuse of the hospital and member claims process
- Act as first point of contact and provide input into correction of issues identified to Senior Management
- Assist in the production and delivery of training materials for TPAs and internal teams to ensure agreed processes and procedures are rolled out effectively

Requirements
The successful candidate must hold an APA qualification (or equivalent) and ideally have 5 years' experience in the insurance industry. They should be customer-focused, motivated, and able to lead by example, driving standards of professionalism within the team. Strong stakeholder management skills and ability to develop and implement training plans are essential.

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

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