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Hospital Claims Officer
3 months ago
About the Role
As Claims Assessor you are responsible for assessing member claims, understanding of Fund policies and procedures and providing accurate information to internal and external stakeholders and providers.
To be successful in this role you must display a high degree of accuracy and detailed understanding of HPPA contracts and terms is essential as is the payment of claims within contract terms.
About HCF
HCF is Australia's largest not-for-profit private health insurer.
With the adoption of our 2020 Strategy, our vision is to make health care understandable, affordable, high quality and customer centric.
About the Role
As Claims Assessor you are responsible for assessing member claims, understanding of Fund policies and procedures and providing accurate information to internal and external stakeholders and providers.
To be successful in this role you must display a high degree of accuracy and detailed understanding of HPPA contracts and terms is essential as is the payment of claims within contract terms.
Reporting to the Hospital Claims Team Leader you be responsible for Claims Assessment, Member Retention and Administration.These key result areas include:
- Assess and process all types of hospital claims within SLA's.
- Assess and review claims in accordance with Fund Rules eliminating overpayments/unnecessary rejections.
- Maintain claims quality by ensuring processing accuracy targets are achieved.
- Maintain error rates below unit KPI's.
- Handle any inquiries and resolve problems to within customer service standards.
- Achieve agreed claim volumes through number of claims/lines processed.
- Process suspense claims and turnaround within standards.
- Respond to enquiries from providers.
- Liaise with HMUR on clinical issues and/or unusual billing practices identified in assessing.
- Resolve member enquiries to ensure customer service standards are achieved.
- Deliver an exceptional customer experience whilst adhering to Fund and SLA's.
- Ensure all member correspondence is within SLA's.
- Ensure members comply with membership claiming requirements.
- Achieve productivity targets as set per unit KPI's.
- Actively assist fellow team members in assessing complicated claims.
- Provide support to Provider Services team, Call Centre and branch staff.
- Identify and make recommendations for improved efficiencies to existing processes and procedures within the unit.
- Regularly shares assessing information with team members.
About your experience
To be successful in this role you will demonstrate the below experience
- A background in claims and Insurance (ideally health) would be ideal.
- Strong attention to detail.
- Excellent communication both written and verbal.
- Ability to adapt positively to changing work practices and needs.
- Ability to work autonomously and set own priorities to ensure unit objectives are met.
- Be an effective team player.
Benefits & culture
We believe in developing our people to assist in driving continuous improvement within the organisation. At the same time we are dedicated to creating a working culture where staff members can flourish. We work hard to ensure that all our positions are challenging and rewarding, where you can utilise and further develop your skills to truly make a difference
