PMI Claims Quality Auditor (Hybrid)

Mercer; Greater London; Hybrid; GBP 55,000 - 80,000; Full time

Job summary

Mercer Marsh Benefits in London is seeking a Private Medical Plan Auditor to join our Workplace Health team. This hybrid role requires three office days per week, with flexibility for candidates from other UK offices.

You will provide independent oversight of Private Medical Trust claims processing by the TPA, ensuring accuracy, compliance with benefit design and authorisation rules, and the quality of the member claims experience.

Qualifications

• Solid experience in PMI claims operations (TPA and/or insurer environment).
• Strong knowledge of PMI benefits and scheme rules.
• Attention to detail is essential.
• Proficient in Microsoft tools.
• Project management: coordinating tasks across client workstreams.
• Scope development: documenting client needs for audit focus.
• Stakeholder coordination with internal teams, TPA and client contacts.

Responsibilities

• Provide independent oversight of PMI Trust claims processing by the TPA to ensure accuracy and compliance with benefit design and authorisation requirements.
• Audit delivery & claims quality across claim types and validate post-payment decisions and payments.
• Identify issues such as over/under-payments, non-covered services and coding errors; quantify impact and recommend corrective actions.
• Produce client-ready audit reports and present findings to stakeholders.

Skills

PMI claims operations

Auditing/QA

Data privacy

Microsoft Office

Project management

Stakeholder coordination

Data gathering

Tools

Microsoft Office

Job description

Mercer Marsh Benefits in London is seeking a Private Medical Plan Auditor to join our Workplace Health team. This hybrid role requires three office days per week, with flexibility for candidates from other UK offices.

You will provide independent oversight of Private Medical Trust claims processing by the TPA, ensuring accuracy, compliance with benefit design and authorisation rules, and the quality of the member claims experience.