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Health Claims Specialist

Irish Life Financial Services Limited -
Cork, County Cork

Apply Now

Job details

Permanent | Full-time
4 days ago

Full job description

Health Claims Specialist

Location: Cork, IE

Company: Irish Life Financial Services Limited

Full Time Permanent position
Hybrid role based in our Dublin City Centre /Cork Office

Fitness & 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 HR.

What we offer

We have embraced a hybrid working model for most of our positions, which means that you can enjoy a balanced approach of working from home for part of the week and working from the office for the remainder of the week.

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

Further details on our benefits package can be accessed here Benefits (life-careers.com)

At Irish Life, our purpose is to help people build better futures. Our company values shape everything we do and underpin our vision of being the driving force behind Ireland’s financial, physical, and mental well-being.

We believe in doing the right thing—acting with integrity and making fair, responsible decisions. We aim high, setting ambitious goals and find better ways to innovate and improve. Our customers are at the heart of everything we do and we are dedicated to understanding their needs and exceeding their expectations. Achieving this is only possible when we work best together—in a supportive, collaborative environment where every idea and contribution is valued.

Role Overview

The Health Claims Specialist plays a critical role in the accurate assessment and payment of both hospital and member claims, ensuring compliance with governance, regulatory and quality assurance standards. The role is responsible for managing pre approvals (local and overseas), team mailboxes, performing governance audits and control reporting. By analysing trends, audit outcomes and claims data, the Health Claims Specialist drives continuous improvement, helping to streamline processes, reduce waste work and deliver a consistently high quality experience for our customers and provider partners. APA PMI qualification preferred.

Key Responsibilities

Complete governance audits for processed hospital and member claims in line with the Quality Assurance Strategy.
Management and oversight of daily control report generation specific to member and or hospital claims and review to ensure the effectiveness of the claim’s governance framework.
Process all local and overseas pre approval requests in accordance with agreed procedures.
Act as the first line of defence in identifying potential inappropriate billing, fraud, waste and abuse within hospital and member claims process.
Actively manage all team mailboxes, ensuring responses and actions are taken within agreed KPIs.
Identify and report ineffective or inefficient controls or claims processes, and provide recommendations for corrective actions to Senior Management.
Identify trends and patterns from member and or hospital audits and claims activity, and support the implementation of appropriate remedial and preventive actions.
Review and maintain documentation (policies, procedures, guidelines) to ensure it is up to date, accurate and relevant.
Identify waste work and opportunities to improve and streamline the claims process, supporting continuous improvement initiatives.
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.
Provide excellent customer service to members and providers, maintaining a strong customer focus in all interactions.

The Person

Holds an APA PMI qualification (or higher).
1–5 years’ experience in health insurance claims assessment.
Customer focused, motivated to make a difference, and keen to contribute to the achievement of business objectives.

About us

Irish Life is one of Ireland’s largest financial institutions with a presence across a range of financial services markets and 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 through Irish Life Health, their health insurance.

Irish Life Health provides Health Insurance to over 500,000 people across Ireland both directly and through Corporate schemes. Our Vision is to help people live healthier lives and we focus on providing access to healthcare solutions that will help our customers do this.

This includes offering services like 24/7 Digital Doctor; access to counsellors through our Healthy Minds programme and expert Physio support for acute back or neck pain across all of our Plans.

The company reserves the right to draw up a shortlist as part of the selection process. Where Agency assistance is required the Irish Life Recruitment Team will engage directly with suppliers. Unsolicited CVs / profiles supplied to Irish Life by Recruitment Agencies will not be accepted for this role.

Irish Life is proud to be an Equal Opportunities employer. We have created an environment of inclusion and growth to help people achieve their potential, to ensure they can bring their whole selves to work and to feel valued. We celebrate diversity of thought and perspective and want all of our employees to feel valued, respected and supported.

We have built a culture that promotes equality and inclusion for all of our current and future employees and strive to ensure that our behaviours, processes and practices are aligned to this culture.

If you require any accommodations during the recruitment process please contact [email protected] and we will be delighted to ensure you are fully supported to be your best.

Irish Life Health supports Equal Opportunity and is regulated by the Central Bank of Ireland.

Apply Now

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