Claims Specialist in Health Operations
The role of a Claims Specialist involves ensuring accurate and timely payment of claims. The specialist will be responsible for:
* Identifying and reporting on ineffective or inefficient controls or claims processes;
* Providing inputs and recommendations into the correction of issues identified to Senior Management;
* Acting as the first line of defence, identifying and managing any potential areas of inappropriate billing, fraud and abuse of the hospital and member claims process;
* Completing governance audits for all processed Hospital and Member Claims in line with our Quality Assurance Strategy as required;
* Paying and declining claims in line with the documented process;
Key qualifications include:
* A strong customer service background putting customers at the centre of what we do;
* Claims audit experience and a good understanding of the principles of governance;
* Proven experience in health insurance with a good knowledge of claims processes, assessment rules, policy terms and conditions;
* Strong commercial focus – recognising emerging risks and concerns to support business retention and cost saving;
* Excellent knowledge of health insurance plans and relevant legislation;
* Excellent communication and interpersonal skills;
* Ability to manage 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;
* Be a self-starter and willing to act on own initiative.
This is a 'controlled function' role, requiring appointment conditional on meeting the requirements set out in the Fitness and Probity standards issued by the Central Bank.
Flexibility is required to work in a hybrid environment with regular presence in City Centre offices/Cork Office. This role requires excellent organisational skills, a proactive approach, and the ability to work independently within a team environment.