Claims Peer Reviewer

4 days ago

Gloucester, Gloucestershire, United Kingdom Pro Insurance Solutions Ltd Full time
Job Summary

We are seeking a highly skilled Claims Peer Reviewer to join our Audit and Advisory team at Pro Insurance Solutions Ltd.

This is an exciting opportunity for a professional with expertise in insurance claims and peer review to work closely with clients and our team to deliver high-quality audits and reports.

Key Responsibilities
  • Lead Claims Peer Reviews
    • Conduct thorough file reviews to identify potential issues and areas for improvement.
    • Build and maintain strong relationships with clients to ensure their needs are met.
    • Produce high-quality reports that meet client requirements and provide clear recommendations for improvement.
    • Liaise with clients to report progress updates, compile work plans, and conduct on-site work as required.
  • Provide SME Support
    • Offer expertise and guidance on insurance claims and peer review to Advisory projects, including Due Diligence.
  • Support TPA Audits
    • Conduct file testing to ensure accuracy and completeness.
  • Liaise with Stakeholders
    • Communicate effectively with all stakeholders to ensure timely delivery of projects and audits within agreed budgets.
  • Review and Analyze Data
    • Review documentation provided by the TPA/client to understand the focus of the audit/peer review.
    • Analyze claims files and populate testing templates to ensure accuracy and completeness.
  • Write Reports
    • Produce clear and concise reports summarizing findings or checking reports to ensure adherence to scope.
Requirements
  • Analytical Skills
    • Ability to review reports, identify issues, and assess their importance.
  • Communication Skills
    • Effective communication with both internal and external stakeholders.
  • Time Management
    • Ability to manage time, meet deadlines, and prioritize tasks.
  • Teamwork
    • Ability to work collaboratively as part of a team.
  • Technical Skills
    • Strong computer skills, including MS Office, intermediate Excel, Word, and PowerPoint.
  • Insurance Experience
    • Experience in claims adjusting and report writing.
  • Personal Qualities
    • Outcome-focused, self-motivated, confident, and enthusiastic.
    • Diplomatic, cooperative, and collaborative in approach.
    • Assertive, persuasive, and resilient.

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