Clinical Assessment Specialist

1 week ago

Melbourne, Victoria, Australia beBeeClinical Full time $110,000 - $130,000

Our organisation is dedicated to delivering wellbeing solutions in Australia. We strive to make a positive impact on people's lives by supporting their wellbeing journey.

As a Clinical Claims Analyst, you will play a crucial role in assessing claim information based on current disease management principles and an understanding of evidence-based surgical and clinical pathways.

This position requires expert clinical assessment skills, with the ability to ensure clinical quality, consistency, and safety of these assessments. Key responsibilities include:

  • Providing expert clinical assessment of claim information based on current disease management principles and an understanding of evidence-based surgical and clinical pathways
  • Documenting clinical assessment outcomes in Salesforce with an appropriate level of rationale for decisions to ensure transparency in decision making
  • Assisting the Compensation & Analysis team with complex pre-existing condition assessment, medical and accident reports
  • Engaging with the Hospital Assessing Team to transfer skills, knowledge, and insights to ensure the outgoing integrity of the hospital claims assessment process
  • Maintaining and sharing knowledge of new technology and other clinical developments coming through the ex-gratia assessment process
  • Conducting hospital/desktop audits as required according to our audit strategy framework

Key Requirements

To be successful in this role, you will need:

  • Bachelor of Health Science in Nursing and current registration with AHPRA as a Registered Nurse
  • Recent acute care clinical experience or equivalent
  • Understanding of MBS, DRGs, Government legislation and regulations particularly relevant to Private Health Insurance

What We Offer

As a valued member of our team, you will enjoy a range of benefits including competitive salary, bonus program, additional yearly wellbeing and community leave days, 14-week paid parental leave, and more.

Additional Information

Experience within the Private Health Insurance industry and extensive knowledge of surgical procedures, terminology and procedural classifications would be highly regarded.

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