Health Insurance Claims Specialist

7 days ago

Melbourne, Victoria, Australia beBeeClinical Full time $100,000 - $120,000

Overview

We are seeking a highly skilled and experienced Registered Nurse to fill the role of Clinical Claims Analyst within our health insurance business.

The Clinical Claims Analyst plays a vital role in ensuring the accuracy, legitimacy, and compliance of health insurance claims and clinical applications.

  • Utilize expert clinical assessment skills to review claim information based on current disease management principles and an understanding of evidence-based surgical and clinical pathways.
  • Document clinical assessment outcomes in Salesforce with an appropriate level of rationale for decisions to ensure transparency in decision making.
  • Collaborate with the Compensation & Analysis team to provide support with complex pre-existing condition assessments, medical reports, and accident reviews.
  • Engage with the Hospital Assessing Team to share knowledge, skills, and insights to maintain the integrity of the hospital claims assessment process.
  • Contribute to the development of guiding principles to ensure evidence-based decision making remains up-to-date with current trends and technology.
  • Review ex-gratia applications for high-cost drugs, non-listed prostheses, and other clinical/treatment items not typically covered within fund rules.

Stay informed about new technologies and clinical developments emerging through the ex-gratia assessment process.

Provide guidance and coaching to new and existing team members in consultation with management.

You will enjoy a range of employee benefits and rewards, including a competitive salary, bonus program, yearly Well-Being and Community leave days, paid parental leave, Employee Referral Program, Employee Assistance Program, Maxxia Rewards, discounts across our business, and access to LinkedIn Learning courses.

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