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About the Role
Provide independent oversight of 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 scheme benefit design, authorisation requirements, applicable fee schedules/tariffs, and internal controls. Review the quality of the member claims experience through their interaction with the TPA, identify areas of digression, support recoveries/corrections, and make recommendations to improve end-to-end claims quality and member experience.
Responsibilities
- Develop and deliver a risk-based audit report across claim types aligned to the Trust’s governance priorities and agreed audit scope.
- Perform post-payment audits of TPA claim decisions and payments to validate member eligibility, benefit entitlement, adherence to pre-authorisation/referral requirements, and quality of member experience.
- Validate the accuracy of claim set-up and adjudication, including documentation completeness, correct benefit selection, and correct application of tariffs/fee schedules, network rules, etc.
- Identify, evidence and quantify issues including over/under-payments, duplicate payments, non-covered services, miscoding/upcoding, unbundling, and processing/administrative errors.
- Organise disparate information into structured findings, analyse audit outcomes to identify root causes, repeat errors, and control weaknesses.
- Translate audit findings into practical recommendations to improve TPA processing quality.
- Produce clear, client-ready audit reports and summaries outlining findings, financial impact, trends, and corrective actions.
- Present audit findings and recommendations to Trust/client stakeholders.
- Comply with all applicable data protection and information security requirements when handling sensitive health data and Trust financial information.
Requirements
- Solid experience in PMI claims operations (TPA and/or insurer environment), with exposure to claims decisioning, authorisations and claims assessment.
- Strong working knowledge of PMI benefits and scheme rules, gained through claims assessment and / or authorisation.
- Attention to detail is essential.
- Proficient in Microsoft tools.
- Experience in coordinating tasks, timelines and deliverables across multiple client workstreams.
- Experience in collecting and documenting client needs to support project scope and audit focus.
- Experience in liaising with internal teams, TPA and client contacts to keep projects aligned and progressing.
- Experience in requesting, obtaining and interpreting insurer information to support case analysis and audit findings.
Skills
- Project management
- Scope development
- Stakeholder coordination
- Data gathering
- Audit methodologies (sampling, root cause analysis, control testing)
- Medical billing/coding familiarity
Location
- London, UK
- Other UK offices
Work Type
- Hybrid
- Full-time
Experience Level
- Prior claims quality/audit experience preferred
- Exposure to high-cost/complex claims and provider billing practices
- Familiarity with audit methodologies
- Understanding of UK employee benefits
Education Level
- Claims/insurance qualifications (local equivalent)
Benefits
- Professional development opportunities
- Interesting work
- Supportive leaders
- Vibrant and inclusive culture
- Talented colleagues
- New solutions creation
- Impact for colleagues, clients and communities
- Range of career opportunities
- Benefits and rewards to enhance well-being
About the Company
- Mercer Marsh Benefits (MMB) are looking for a Private Medical Plan Auditor to join our Workplace Health team.
- Marsh (NYSE: MRSH) is a global leader in risk, reinsurance and capital, people and investments, and management consulting, advising clients in 130 countries.
- With annual revenue of over $27 billion and more than 95,000 colleagues, Marsh helps build the confidence to thrive through the power of perspective.
- Marsh is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office.
- All Marsh colleagues are expected to be in their local office or working onsite with clients at least three days per week.
- Office-based teams will identify at least one “anchor day” per week on which their full team will be together in person.
Equal Opportunity
- Marsh is committed to embracing a diverse, inclusive and flexible work environment.
- We aim to attract and retain the best people and embrace diversity of age background, civil partnership status, disability, ethnic origin, family duties, gender orientation or expression, gender reassignment, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, or any other characteristic protected by applicable law.
- We are an equal opportunities employer.
- We are committed to providing reasonable adjustments in accordance with applicable law to any candidate with a disability to allow them to fully participate in the recruitment process.
- If you have a disability that may require reasonable adjustments, please contact us at reasonableaccommodations@marsh.com.