Health Claims Specialist Position
4 days ago
Irish Life Group Services Limited is seeking a motivated and driven Health Claim Specialist to join their team.
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.
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.
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.
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