Job Title: Team Leader - Claims Operations
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.
The Role:
We are looking for a motivated and driven Team Leader to join our Claims Operations team. As a Team Leader, you will be responsible for the smooth running and overall effectiveness of the team. You will work closely with the Health Claim Service Manager to ensure that high quality standards are maintained at all times and that service and quality standards are met.
Your Key Responsibilities:
* Focus on delivering customer first solutions to maximise our customer experience.
* Day to day co-ordination of the team service levels and workload.
* Oversight of service levels for our providers interaction activities (Voice & Email), all assigned claim productivity targets, ICD coding requirements to ensure KPIs are met.
* Ensuring all claim payments are made to the right payee, at the right time, with a focus on accuracy.
* Complete governance audits for all claims and verify all minimum audit levels are met in line with our Quality Assurance Strategy including ICD coding completed on claims.
* Ensure all governance requirements are adhered to and are fully auditable.
* 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 and internal teams to ensure that the agreed processes and procedures are rolled out effectively in a controlled manner.
* Lead by example and uphold the standards of professionalism expected of the team.
* Build positive and proactive working relationships across the organisation as well as with our TPAs.
Your Skills and Experience:
* Hold an APA qualification (or equivalent).
* Ideally have 5 years' experience in the insurance industry.
* Customer focused and motivated to make a difference and play a very significant part in the delivery of our business objectives.
* Clinical background to support on the development of the ICD coding internal team.
* Self-starter and willing to act on own initiative.
* Ability to develop and implement training plans and successful roll out to team members.
* Ability to manage a demanding workload while co-ordinating work effectively across the team.
* Lead by example and drive standards of professionalism within team.
* Strong stakeholder management skills.
* Act as part of a team and give full participation and commitment to fellow team members to meet common goals.
* Ability to deputise and set up for Health Claims Service Manager.
* Experience in health insurance with an excellent knowledge of claims processes, assessment rules, policy terms and conditions is desirable.
* Good understanding of the principles of governance is desirable.
* Excellent communication and interpersonal skills.
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.