Claims Quality & Support Officer

Employment Type: Full Time Maternity Leave contract 

Join a team where quality, accuracy and innovation matter

We're looking for a detail-oriented Claims Quality & Support Officer to help drive excellence across our health and medical claims operations. In this role, you'll be responsible for auditing claims decisions, identifying process improvements, ensuring regulatory compliance, and supporting a culture of continuous learning and operational excellence.

This is an exciting opportunity for someone with a background in medical claims, health insurance, TPA operations, clinical administration, or medical coding who enjoys combining analytical thinking with quality assurance and process improvement.

As our business continues to evolve through digital transformation and enhanced data-driven decision making, you'll play an important role in helping maintain accuracy, consistency, and quality standards across claims operations.

What you'll be doing

• Conduct quality reviews and audits on medical claims processing and adjudication activities
• Assess claims decisions against established policies, procedures, regulatory requirements, and quality standards
• Identify trends, root causes, and opportunities for process improvement through audit findings and quality analysis
• Prepare clear, concise, and actionable audit reports and recommendations
• Provide quality feedback to claims examiners and contribute to performance scorecards and coaching initiatives
• Review and interpret medical records, coding standards, reimbursement guidelines, and health plan requirements
• Validate claims documentation and identify inconsistencies, anomalies, or potential fraud and abuse indicators
• Support regulatory audit requirements and ensure compliance with internal and external standards
• Produce monthly reporting and insights on quality performance, findings, and improvement opportunities
• Collaborate with stakeholders to implement corrective actions and enhance operational effectiveness
• Contribute to initiatives that support smarter workflows, quality optimisation, and continuous process improvement

What you'll bring

Essential

• 3-5 years' experience in a customer-focused environment, ideally within:
  • Health insurance
  • Medical claims
  • Third Party Administration (TPA)
  • Clinical or paramedical environments
  • Quality assurance or audit functions
• Strong understanding of medical claims processes and adjudication practices
• Experience identifying claim variances, errors, and quality issues
• Excellent analytical and problem-solving skills
• Strong written communication and reporting capability
• High attention to detail and the ability to work independently
• Proficiency in Microsoft Office and digital systems

Desirable

• Bachelor's degree in a Medical, Paramedical, Finance, Business Administration, Insurance, or related discipline
• Knowledge of:
  • ICD-9 / ICD-10
  • CPT
  • HCPCS
  • UB Billing Codes
• Experience auditing healthcare providers, payers, or medical records
• Exposure to fraud detection, compliance reviews, or risk management activities
• Experience using data, reporting tools, or digital technologies to support quality outcomes

Why join us?

• Hybrid working arrangements
• Career growth within a global and evolving organisation
• Opportunity to work in a highly specialised healthcare and insurance environment
• Collaborative and supportive team culture
• Exposure to quality improvement, operational excellence, and emerging digital capabilities
• The chance to make a meaningful impact on customer outcomes and claims quality standards

Ready to apply?

If you're passionate about quality, enjoy working with complex claims information, and thrive in an environment focused on continuous improvement and smarter ways of working, we'd love to hear from you.

Apply now and help shape the future of claims quality and operational excellence.