Claims Assessor

2 weeks ago

Sydney Central Business District, Australia HCF Full time

**About RT Health**

There aren't many organisations in Australia that can lay claim to such a long history or to being Australia's first registered health fund, but we can. rt health is a not for profit organisation that provides health cover to transport and energy industry employees, and continues to grow today to ensure we provide simple health insurance solutions and great value to our members.

**About the role**

The Claims Assessor - Medical role is responsible for processing high volumes of medical claims. In addition, this role has a strong customer service focus, and it is essential that accurate information and exceptional service is provided in responding to enquiries raised by internal customers, members, Medicare Australia and providers. A thorough understanding of the funds policies and procedures are required.

**Key responsibilities**

**The responsibilities of the role include but are not limited to the following**:

- Assess and process all types of medical claims within SLA’s
- Review and pay medical claims in accordance with Fund Rules and policies
- Maintain claims quality by ensuring processing accuracy targets are achieved and error rates are below unit KPI’s
- Achieve productivity targets as set per unit KPI’s
- Processing of No Gap & Known Gap Medical claims using claims managements systems
- Process rejected, refused, suspended and adjusted claims within standards
- Respond to enquiries from providers
- Perform medical claims adjustments and initiate follow up/recovery action as required
- Action reports and perform quality review processes as required
- Actively assists fellow team members in assessing complicated claims
- Provide support to Call Centre on claims related queries

**About you**

To be successful in this role, you will demonstrate the following qualifications, experience and skills:

- Excellent communication both written and verbal
- Previous proven experience of processing claims
- Sound understanding of the Fund’s products and services
- Ability to work autonomously and set own priorities to ensure unit objectives are met
- Accuracy of data input skills
- Be an effective team player
- Intermediate PC skills in Outlook, Excel, Word and fund management systems
- Sound understanding of medical terminology
- Ability to set own priorities to ensure unit objectives are met

Desirable:

- Previous experience processing ancillary or medical claims transactions
- Previous experience in provider fraud detection
- Experience in the Private Health Insurance Industry

**Culture**

Working in the health insurance industry, we know how important it is to prioritise the wellbeing of our own people. We’re all about creating a fantastic people experience, guided by our values, so that we can in turn better deliver for our members. We work with our people to create a work experience that is inclusive, supportive, safe and respectful so we can do the best for our members.

Come and join our RT Health team

**Benefits**
- Up to 50% discount on health cover, pet & travel insurance
- Flexible work arrangements
- Family & Friends day
- Organisational wide Recognition & Rewards program
- Generous Parental Leave Scheme
- Certified Family Friendly Workplace
- Health & Wellbeing Initiatives

**A career with us - How to Apply

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