Full Time Permanent position
Hybrid role based in our Dublin City Centre or Cork Office (South Mall)

Irish Life Health is part of the Irish Life Group of companies. The Claims Operations function is looking for a motivated and driven Health Claim Specialist to join their team. The successful applicant will be part of a driven team who ensure high quality standards are maintained at all times, working to achieve service and quality standards and striving towards the perfect customer experience

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 Purpose

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 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 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.

Skills and Experience

• Proven experience in health insurance with a good knowledge of claims processes, assessment rules, and policy terms and conditions.

• Claims audit experience and a good understanding of governance principles (desirable).

• Excellent knowledge of health insurance plans and relevant legislation.

• Strong IT skills with the ability to work confidently across multiple systems, including advanced proficiency in Microsoft Excel (e.g. formulas, data analysis, reporting

• Excellent communication and interpersonal skills.

• Self starter, able to work on own initiative.

• Proven ability to manage a demanding workload and prioritise effectively.

• Strong team player with a commitment to supporting colleagues and achieving common goals.

• Good systems knowledge and proficient in Microsoft Office.

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.

Application Process

If you feel you would be a great fit for this role, please discuss your interest in the position with your line manager first.

We then welcome you to submit your application (CV and Cover Letter) via the SuccessFactors portal. Applications are to be made through this location only, we don’t accept email applications. If you are currently an External Contractor working in the Group, please contact LifeCareers@irishlife.ie for further details before submitting an application.

Please note the closing date for receipt of applications is 24/03/2026. If the Employee Referral Programme applies to this opportunity, the deadline for submitting referrals is the same date as above. Applications/Referrals will not be accepted after this date. The post will be advertised across the Irish Life/ Canada Life Group.

If this role is a Permanent role and you are successful in this selection process, the standard terms and conditions of the new role (and if applicable new business unit) apply. The new terms and conditions may differ from your current terms and conditions. These changes may affect benefits such as Health benefit/allowance, Flexi leave/Flexi time arrangements, Pension Contributions or your Bonus range so it is very important to check and understand what changes may apply to you should you be successful in the selection process.

If this is a Secondment opportunity and you are successful in the selection process, a secondment allowance may be payable if your job grade increases with this appointment. In the event that this Secondment role becomes a Permanent role, management reserves the right to offer the secondee the permanent role without re-advertising the role. It is important that you consider this when deciding to submit an application for the Secondment role.

We reserve the right to form a panel (as deemed appropriate by HR) and to select a shortlist from the applications received. The selection process employed will be at the discretion of the Group. We have sized this role at the job grade noted above however we reserve the right to underfill this role if required, at the grade most suited to the successful candidate in the process.

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

Health Claims Specialist

Benefits

Job Description