Medical Claims Officer
3 weeks ago
**About HCF**
At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we’ve been putting our members and their health first. As Australia’s largest not-for-profit health fund, we cover over 1.7 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member centric.
We want to be true health partners to our members, easily guiding the healthcare choices that are right for them. At HCF, our values are the way we do things and create the necessary culture to help us realise our purpose and deliver our 2025 Strategy. Living our values in action we step forward, walk in their shoes, stay human, make it better and get there together.
**About the Role**
Reporting to the Medical Team Leader, this role is responsible for processing high volume medical claims. In addition, this role has a strong customer service focus, and it is essential that accurate information and exceptional service in provided responding to enquiries raised by internal customers, members, Medicare Australia and providers. A thorough understanding of the funds policies and procedures are required.
**Responsibilities**:
Key responsibilities will include:
- Assess and review all types of medical claims
- 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
- Registering Medicover providers and updating provider details, maintain medical provider records and contract details
- Processing of No Gap & Known Gap Medical claims using “PreMac” User interface
- Process rejected, refused, suspended and adjusted claims, using WHICS system
- Maintain medical provider records and contract details
- Perform medical claims adjustments and initiate follow up/recovery action as required
- Action reports and perform quality review processes as required
- Proactively respond to enquiries from Medicare Australia and providers
**About you**:
To be successful in this role you will demonstrate the below experience
- Previous experience within claims, call centre or administration
- Intermediate PC skills including keyboard and accuracy of data input skills
- Ability to adapt positively to changing work practices and needs
- Proficient understanding of WHICS, ECLIPSE, “PreMac” especially in relation to reassessments and claims processing
- Ability to set own priorities to ensure individual and team targets are achieved / exceeded
- Ability to communicate verbally effectively and courteously and in writing to both internal and external customers
- Ability to work autonomously and set own priorities to ensure unit objectives are met
**Culture**
Working in the health insurance industry, we know how important it is to prioritise the wellbeing of our own people. We want to provide you with the skills and tools you need to support your wellbeing journey, so that you can be at your best.
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 HCF team
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