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Health Claims Service Team Lead

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Canada Life

13d ago

  • Job
    Full-time
    Senior Level
  • Customer Relations
    People, HR & Administration
  • Dublin

AI generated summary

  • You need an APA qualification, 5 years in insurance, customer-focused, self-starter, strong leadership, health claims knowledge, governance understanding, excellent communication, and MS Office skills.
  • You will coordinate team activities, ensure service level KPIs are met, conduct audits, manage mailboxes, identify process inefficiencies, and foster relationships with TPAs and internal teams.

Requirements

  • The successful person must hold an APA qualification (or equivalent) and will ideally have 5 years’ experience in the insurance industry.
  • 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.
  • Be a self-starter and willing to act on own initiative.
  • Ability to manage a demanding workload while co-ordinating work effectively across the team.
  • Ability to lead by example and drive standards of professionalism within team.
  • Experience in health insurance with an excellent knowledge of claims processes, assessment rules, policy terms and conditions are desirable.
  • A good understanding of the principles of governance is desirable.
  • Excellent communication and interpersonal skills.
  • 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.

Responsibilities

  • Focusing on delivering customer first solutions to maximise our customer experience.
  • Day to day co-ordination of the team service levels and workload.
  • Oversight of the service levels for our providers interaction activities (Voice & Email) and ensuring KPIs are met.
  • Complete governance audits for all claims and verify all minimum audit levels are met in line with our Quality Assurance Strategy.
  • 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 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.

FAQs

Do we support remote work?

Yes, we support remote work in a hybrid format, allowing employees to work from home for part of the week while working from the office for the remainder of the week.

What are the working hours for this position?

This is a full-time permanent position, but specific working hours are not detailed in the job description.

Is there a minimum qualification required for this role?

Yes, the successful person must hold an APA qualification (or equivalent) to be eligible for this role.

How many years of experience are preferred for this position?

Ideally, candidates should have 5 years of experience in the insurance industry.

What type of benefits does the company offer?

The company offers a comprehensive benefits package, including competitive salaries, bonuses, robust learning and development support, an excellent defined contribution pension, and comprehensive wellbeing initiatives.

Are there opportunities for training and development?

Yes, the company provides robust learning and development support.

What is the role of the Health Claims Service Team Lead?

The Health Claims Service Team Lead is responsible for the smooth running and overall effectiveness of a Claims Operations team, ensuring high-quality standards, achieving service and quality standards, and striving for an excellent customer experience.

What skills are necessary for success in this role?

Necessary skills include being a self-starter, managing a demanding workload, leading by example, having experience in health insurance, understanding governance principles, excellent communication skills, teamwork, and proficiency in Microsoft Office.

What are the key competencies required for this position?

Key competencies include leadership, planning and organizing, communication and influencing, teamwork and cross-functional collaboration, commercial awareness, and risk and control.

Is this role regulated by any financial authority?

Yes, this role is a 'controlled function' as defined by the Central Bank Reform Act and is subject to fitness and probity standards set by the Central Bank of Ireland.

Is the company an equal opportunity employer?

Yes, Irish Life is proud to be an equal opportunities employer and fosters an inclusive environment for all employees.

How can I request accommodations during the recruitment process?

You can contact lifecareers@irishlife.ie to request any accommodations during the recruitment process.

Canada Life

Helping Canadians improve their financial, physical and mental well-being.

Finance
Industry
10,001+
Employees
1847
Founded Year

Mission & Purpose

At Canada Life, we’re focused on improving the financial, physical and mental well-being of Canadians. Whether handling policy claims, help growing and protecting clients’ retirement and investment savings, providing workplace mental health support for all employers or helping build stronger communities by investing in community projects, we are committed to putting the customer first in all that we do. That trust is built on the dedication, skill and energy of our employees and advisors and their commitment to our customers and to our communities. Canada Life is a subsidiary of Great-West Lifeco Inc. and is a member of the Power Corporation group of companies.