Private Medical Plan Auditor — Claims Quality & Compliance

NACBA; Greater London; Hybrid; GBP 55,000 - 75,000; Full time

Job summary

Mercer Marsh Benefits (MMB) in London is seeking a Private Medical Plan Auditor to provide independent oversight of our clients' PMI claims processing by the Third-Party Administrator, ensuring accuracy and compliance with benefit design and governance.

The role covers audit delivery, reporting, data privacy, and stakeholder interaction, with a hybrid work arrangement requiring three in-office days per week and flexibility for other UK offices.

Qualifications

• Solid experience in PMI claims operations with exposure to claims decisioning.
• Strong working knowledge of PMI benefits and scheme rules.
• Attention to detail is essential.

Responsibilities

• Audit delivery and claims quality across PMI claim types.
• Perform post-payment audits of TPA decisions and payments.
• Validate claim setup, adjudication, tariffs and network rules.
• Identify over/under-payments, miscoding and processing errors.
• Produce client-ready audit reports with findings and recommendations.
• Ensure compliance with data privacy requirements.

Skills

PMI claims ops

TPA/insurer experience

Attention to detail

Project management

Scope development

Stakeholder coordination

Data gathering

Education

PMI/insurance quals

Tools

Microsoft Office

Job description

Mercer Marsh Benefits (MMB) in London is seeking a Private Medical Plan Auditor to provide independent oversight of our clients' PMI claims processing by the Third-Party Administrator, ensuring accuracy and compliance with benefit design and governance.

The role covers audit delivery, reporting, data privacy, and stakeholder interaction, with a hybrid work arrangement requiring three in-office days per week and flexibility for other UK offices.