Aps5 Claims and Payments Integrity Officer

1 month ago

Adelaide Region SA, Australia Chandler Macleod Full time

**Location**
***
- Adelaide Bc, South Australia**Category**
***
- Accounting & Finance**Salary**
- $55.24 AUD - $603 AUD Hourly**Posted**
- 01-Nov-2023**Work type**
- Casual/Temp**Contact**
- Teresa Zanatta**Reference**
- BH-153342**Applications close by 4pm Wednesday 8th of November 2023.**

**Mandatory: Australian Citizenship required to work within Federal Government**

**Our Federal Government client is seeking to engage in multiple APS5 Claims and Payments Integrity Officer for a 12-month assignment with potential extension in ADELAIDE CBD**

**About the Team**
The Claims and Payments Integrity section comprises of two teams:
The Claims and Payments Assurance Team is responsible for payments assurance control testing for the Provider Payment Correctness (PPC) and Self-Managed Participant Payments (SMP) Programs. It is also responsible for engaging with the Scheme Actuary Group to request the payments sample (Primary Program) and generate a statistical sample in SES (Secondary Program) to be assessed to return the outcome of the assurance activities for the purpose of determining the error rate, and to complete relevant surveys. The team is responsible for engaging with providers and participants to request information and
supporting evidence to facilitate assurance activities of the sampled payments. It reports on outcomes of assurance activities and assists with remediation. It is also responsible for establishing and maintaining internal and external relationships to improve the payments control environment.
The Claims and Payments Integrity Team is responsible for implementing detective and preventative measures that will reduce claims and payments error and improve compliance through performing a combination of manual validation checks and systematic risk & behavioural analytics. The team is responsible for engaging with providers, plan managers and participants to increase the testing and validation of claims and to also design and implement control measures that are preventative. It reports on outcomes of detective and preventative validation activities and assists with remediation. It is also responsible for establishing and maintaining internal and external relationships to improve the claims and
payments control environment.

**About the Role**
The APS5 Claims and Payments Integrity Officer will provide operational support and advice in relation to complex problems. It may be required to coordinate and assist in the strategic planning, program and project management and policy development that support the NDIA’s objectives to “build a world-leading National Disability Insurance Scheme”.

The APS5 Claims and Payments Integrity Officer will have a considerable level of public contact in relation to complex, difficult or sensitive issues. It may liaise with a range of internal and external stakeholders in a representational role on behalf of the branch/division/NDIA.
**Key skills required for role**:

- Applies judgement, intelligence and common sense.
- Communicates clearly and concisely.
- Applies and builds appropriate knowledge, skills and experience.
- Adapts to, supports and manages change.
- Effectively manages time and resources to ensure that work is completed efficiently.

**Desirable skills to have for the role**:

- Thinks strategically and maximises work linkages, opportunities and solutions.
- Supports shared purpose and direction.

**Responsibilities may include but are not limited to**:

- Undertaking control and conformance testing and providing administrative support for the PPC and SMP Programs.
- Providing input to appropriate assurance and compliance reports to articulate outcomes of reviews and actions required including delivering compliance decisions to participants and providers.
- Modifying test documentation (Test Guides and Test Forms) to ensure assurance program relevancy.
- Undertaking reviews of targeted claims through engagement with providers, plan managers and participants.
- Contributing to the design of new detective and preventative controls using a combination of manual validation check and systematic analytics.
- Working with various teams to investigate, report on and escalate claims and payments anomalies.

(NOTE: the key responsibilities of the role are based on current priorities and may change over time)

**It is highly desirable that the successful applicant understand or lived experience in the field of disability.**

**What's on Offer?**

**- Position located in ADELAIDE CBD**

**- APS5 $55.24/ph + super**

**- Temporary contract for 12 months, with possibility to extend**

**- Standard Hours or work - Monday to Friday, 8:30 am till 5:00 pm 37.5hrs per week**

If you are interested in the role and you have the right experience for the position. CM123

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