The opportunity:
We are recruiting for an experienced Claims Auditor on a permanent basis who will primarily be auditing internal and external complex clinical and non-clinical claims files external suppliers. This key role within our Claims Function provides an exciting opportunity for the right candidate to help the Audit Team shape future developments and promote quality improvement within the Claims function at NHS Resolution.
What you’ll be doing:
After successful completion of initial training, you will be reviewing and evaluating systems, processes, and initiatives and the operational function of the Team. As well as working with the Audit Team Manager to both inform the audit process and monitor the delivery of actions arising from audit recommendations.
You will also be expected to provide support in the setting of strategy and the implementation of new policies affecting all claims schemes, assist and provide support in the monitoring of delivery against NHS Resolution’s Business Plan and on the formulation of implementation plans for the introduction of service changes in conjunction with the Audit Team Manager.
The day-to-day focus of the role will be the audit of internal claims files across all schemes administered by NHS Resolution, including complex clinical and non-clinical claims (appropriate training and mentoring will be provided to the successful candidate if e.g. they only have knowledge of either non-clinical or clinical claims). You will assess file handling against legal requirements, internal policies, best practice standards and agreed claims management expectations, identifying areas of good practice as well as opportunities for improvement.
You will also audit the work of external suppliers, including legal panel firms, costs panel firms, loss adjusters and other providers, to monitor compliance with contractual requirements, performance standards and service expectations. This will involve reviewing evidence, analysing findings, preparing clear audit reports and making practical recommendations to support quality improvement, consistency and effective risk management across the Claims function.
About the team:
The Claims Audit Team is a highly skilled and versatile group of professionals responsible for conducting comprehensive audits of clinical and non-clinical claims files. With a keen eye for detail and a deep understanding of auditing principles, they ensure accuracy, compliance, and integrity in claims processing. Utilising advanced techniques and industry-specific knowledge, they provide actionable insights and recommendations to improvement, efficiency, quality, and risk mitigation. Collaborating closely with stakeholders including external and internal audiences. Committed to upholding ethical standards and maintaining confidentiality, they play a crucial role in safeguarding the organisation's reputation and objectives, and ensure all parties are appropriately equipped to handle case management in the claims function.
What we’re looking for:
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Extensive personal injury and/or clinical negligence claims handling experience or equivalent knowledge and skills or post graduate qualification.
- Auditing experience.
- Excellent written and oral communication skills with the ability to communicate at all levels, sometimes in sensitive and or hostile environments.
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An ability to make decisions and be willing to highlight poor service delivery.
- Outstanding interpersonal, skills requiring diplomacy and professionalism.
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Ability to manage several priorities at the same time.
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Ability to work under pressure and to tight and immovable deadlines.
What does the current auditors say:
“Joining the audit team is an excellent opportunity to work with fantastic managers and colleagues to review and maintain the high quality of case handling expected from our case managers whilst also identifying and driving areas for improvement.
As an auditor, I, along with colleagues have been empowered to create, lead and contribute towards new audit projects for the benefit of the organisation. The encouragement provided to develop new audit projects, whilst performing everyday tasks is a testament to the professional and supportive nature of the audit managers and team members where everyone feels comfortable to contribute and assist in the success of various projects.”
‘Working in the audit team has helped broaden my understanding of claims management, the internal claims processes, and NHS Resolution’s vision and values. The scope and nature of audits vary from auditing claims from across the different indemnity schemes that NHSR operate to auditing Panel performance. The team is close knit, extremely friendly and regularly collaborate’. A former NHSR Case Manager
“In my previous role as a Claimant PI solicitor, I found myself always thinking about my files during the evenings / weekends there was nothing quite like the feeling of sitting down to watch television on a Sunday evening and suddenly remembering the vast schedule of loss which had to be drafted the following day. Before going on annual leave, I would work long days to make sure my caseload was all up to date, only to return to the office and be faced with all of the work my pre-holiday efforts had generated. What I enjoy so much about my role in audit is that fact that once I have audited a file, that is it and I no longer have to think about it. I now have a much better work / life balance.”
"What I enjoy about working in the audit team, aside from how friendly (and it might surprise you to know fun) and supportive the team are, is the exposure to a really diverse range of work."
Who we are
We are NHS Resolution, an arm’s length body operating under the Department of Health and Social Care. At our core, we specialise in claims management, dispute resolution, and knowledge sharing within the NHS. Our purpose is to provide expertise to the NHS to resolve concerns fairly, share learning for improvement and preserve resources for patient care.
Our Claims directorate is responsible for managing a total of ten indemnity schemes covering clinical and non-clinical legal liabilities of NHS organisations in England and independent sector providers of care to NHS patients.
The NHS Resolution Claims Management function has embarked on a transformation and expansion programme with a vision to deliver a single, integrated claims function, with a supportive organisational structure that avoids duplication of effort and allows teams to develop their skills.
What we offer in return
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Competitive salary and benefits package
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We are a committed flexible and family-friendly working organisation supporting individuals in having a work and life balance
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Opportunities for career growth and development
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Collaborative and innovative work environment
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Work in a progressive environment towards data-driven strategies
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A commitment to diversity, equality, and inclusion
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Access to the NHS Pension Scheme and a minimum of 27 days Annual Leave.
- Commitment to support individuals in having a work and life balance, offering flexible working arrangements
When joining the NHS family, there are a wealth of savings, discounts and support you will be able to access
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24 hours employee assistance programme from PAM Wellness (EAP)
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Eye care vouchers for Specsavers
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Health service discounts
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Blue Light card, a discount service for the emergency services and the NHS
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Cycle to work scheme
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Season ticket loan scheme
At NHS Resolution (NHSR), we pride ourselves on recruiting talented individuals from a wide array of professional backgrounds. While many of our team members come from the NHS, we also welcome expertise from insurance companies, legal firms, technology sectors, and everything in between. Our commitment to diversity means we value the unique perspectives and experiences that individuals from all walks of life bring to our organisation. By fostering an inclusive environment, we ensure that our team reflects the rich diversity of the communities we serve.
