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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 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 project management: Coordinating tasks, timelines and deliverables across multiple client workstreams.
Experience in scope development: Collecting and documenting client needs to support project scope and audit focus.
Experience in stakeholder coordination: Liaising with internal teams, TPA and client contacts to keep projects aligned and progressing.
Experience in data gathering: Requesting, obtaining and interpreting insurer information to support case analysis and audit findings.

Skills

Claims decisioning
Authorisations
Claims assessment
PMI benefits
Scheme rules
Microsoft tools
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

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 embracing a diverse, inclusive and flexible work environment.
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.