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Ancillary Claims Examiner

2 months ago

Docklands, Victoria, Australia Medibank Full time
About the Role

We are seeking a skilled Ancillary Claims Auditor to join our team at Medibank. As a key member of our Payment Integrity Ancillary team, you will play a critical role in preventing improper payments and benefit leakage through detection, monitoring, prevention, and investigation of fraud, abuse, waste, and error.

Key Responsibilities
  • Identify, review, and assess health service providers, members, and staff to ensure compliance with Medibank's recognition criteria, Fund Rules, and industry standards.
  • Conduct intelligence-led and data-driven identification of irregular claiming activity.
  • Undertake testing of identified rules to determine size and scope of the behavior, potential return on investment, and any other contributing factors or risks.
  • Prioritize activities based on return on investment, quality of care to our members, and the member's experience.
  • Conduct reviews adhering to the principles of natural justice and procedural fairness.
  • Undertake root cause analysis and provide recommendations for remediation of systemic issues.
  • Report results, make recommendations in a logical, clear, and concise manner in a format consistent with Medibank's guidelines.
  • Maintain accurate, comprehensive, and timely case management records, in accordance with policies and procedures.
About You
  • You are a natural problem solver with great communication skills and attention to detail.
  • You can liaise with people at all levels in an informative, accurate, and positive manner.
  • You have a keen eye for detail, are analytical, and have the ability to detect, interpret, and report on patterns and trends.
  • You can identify relevant information from multiple information sources, including regulatory requirements, internal policies, and business rules and data sources while evaluating risk and return on investment.
  • You are able to prioritize, organize, and complete work within established deadlines, and maintain a consistent level of accuracy and professionalism.
  • You can work as a team and autonomously within a structured environment.
  • You are proficient in Microsoft Office products, with accurate word processing and data manipulation skills.
  • You have good working knowledge of Excel at an intermediate level, including an understanding of pivot tables and use of formulas and charts.
  • Previous experience in a claim audit role is highly desirable.
What We Offer

At Medibank, we believe work is something we do, not somewhere we go. Our modes of working – Collaboration, Connection, and Concentration – help inform how your day is structured and where you choose to work will vary, depending on your role and requirements.

The wellbeing of our employees is our priority. We encourage you to talk to us about any additional support you may require during the recruitment process, as well as how this role can be flexible for you. We encourage applications from candidates with a disability, if you require any adjustments or alternate formats of key information at any stage of the recruitment process, we welcome hearing from you via [insert contact details].

We offer a range of great benefits such as subsidised private health insurance, rewards and discounts, and health and wellbeing initiatives. To find out more, click here.