Aps5 Claims and Payments Integrity Officer

2 weeks ago

Adelaide Region SA, Australia DFP Recruitment Services Full time

**Job description**:
Our client is currently seeking an APS5 Claims and Payments Integrity Officer to join the team within a Federal Government Agency based in the Adelaide CBD.

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

**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
- Previous experience in a similar environment
- 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.

This role is at the APS5 level equivalent offering $55.24 per hour + 11% super. The rate of pay is casually loaded, as you will not be accruing annual or sick leave.

As this role is within the Federal Government, applicants are required to be Australian Citizens to be considered.

If you are interested in this role, please APPLY NOW or call Tyler Waterhouse on 8400 4433 for more information.

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