Private Medical Plan Auditor

Job description preview

From Marsh McLennan’s original posting

Company: Mercer Description: Mercer Marsh Benefits (MMB) are looking for a Private Medical Plan Auditor to join our Workplace Health team in London, although for the right candidate we may consider candidates based from our other UK offices. This is a hybrid working role, with a requirement work three-days per week in the office. Role overview - To provide independent oversight of our clients’ Private Medical Trust’s claims processing performed by the Third-Party Administrator (TPA), ensuring claims authorisation decisions and payments are accurate and compliant with the scheme benefit design, authorisation requirements, applicable fee schedules/tariffs, and internal controls. The role also reviews the quality of the member claims experience through their interaction with the TPA. The role identifies areas of digression from the benefit design or authorisation requirements, supports recoveries/corrections where appropriate, makes recommendations to improve end-to-end claims quality and the member experience through insight and corrective actions. We will count on you to: Audit delivery & claims quality • Develop and deliver a risk-based audit report across claim types (e.g.,…