Health Claims Administrator Position

4 days ago


Dublin, Dublin City, Ireland Irish Life Group Services Limited Full time
Company Overview
Irish Life Group Services Limited is a leading financial services group with over 1.5 million customers across various markets. We have been helping people look after their life insurance, pension, and investment needs for over 80 years.

Job Description

This role is part of the Claims Operations function, responsible for reviewing medical claims and assigning ICD-10 codes in line with coding requirements. The successful applicant will be actively involved in the development of clinical coding teams and attend relevant training courses and system updates as required.

The key responsibilities include ensuring 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 attending any relevant training courses and system updates as required.

Additionally, this role involves completing governance audits for all processed Hospital and Member Claims in line with our Quality Assurance Strategy. Completing all local and overseas pre-approval in line with agreed procedures.

The individual selected will 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 managing 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.


Required Skills and Qualifications
  • AAP qualification (or higher) and 1-3 years' experience in health insurance claims assessment and ICD-10-AM clinical coding
  • Ideal candidate will have knowledge of health insurance plans and relevant legislation
  • Excellent communication and interpersonal skills, being a self-starter and willing to act on own initiative


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