Specialist - Claims/Underwriting

Role Overview

Irish Life Health was created in August 2016 by the combination of Aviva Health and GloHealth. The company is part of the Irish Life Group of companies. 

The Claims Operations function is looking for three new team members who are driven and ambitious and looking to progress their careers.

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

This is an ideal opportunity to move into an exciting and challenging role and to develop a career within a very successful and ambitious company. This is a Minimum Competency role covered under the terms of the Central Bank requirements. 
 

The key responsibilities of the role will include:

• Complete governance audits for all processed Hospital and Member Claims in line with our Quality Assurance Strategy as required.
• Liaise with relevant TPAs for overseas cases as required
• Complete all local and overseas pre approval in line with agreed procedures
• Manage audit process in line with QA strategy
• Ensure all governance requirements are adhered to and are fully auditable
• Act as the first line of defence, identify and manage any potential areas of inappropriate billing, fraud and abuse of the hospital and member claims process. 
• Manage Third Party claims and rebates in line with process
• Actively manage all team mailboxes in line with agreed KPIs
• Support the provider support mailbox and voice team 
• 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
• Flexibility to support all aspects of the operation

The Person:

The successful person will hold an APA qualification (or higher) and will ideally have 3 years’ experience in claims processing within Health Insurance. 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

• 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 
• Good system knowledge and use of Microsoft Office

Key Competencies

Fitness and 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. This requires the company to complete prescribed due diligence to assess the appointee’s fitness and probity. Further details on this due diligence process are available from ILIM Human Resources.