Clinical Application Specialist

2 weeks ago

Melbourne, Victoria, Australia beBeeAnalytical Full time $90,000 - $120,000
Key Responsibilities

The Clinical Claims Analyst is a highly skilled registered nurse responsible for ensuring the accuracy, legitimacy and compliance of health insurance claims and clinical applications.

This role plays a vital part in assessing claim information based on current disease management principles and an understanding of evidence-based surgical and clinical pathways.

As a member of our team, you will provide expert clinical assessment outcomes in Salesforce with an appropriate level of rationale for decisions to ensure transparency in decision making.

  • Assess and review ex-gratia applications for high-cost drugs, non-listed prosthesis and other clinical/treatment items not ordinarily covered within fund rules.
  • Provide clinical evidence as support for ex-gratia decisions (approval and denial) to ensure guiding principles remain current.
  • Conduct hospital/desktop audits as required according to Australian Unity's audit strategy framework.
Required Skills & Qualifications
  • Bachelor of Health Science in Nursing & current registration with AHPRA as a Registered Nurse.
  • Relevant post-graduate qualification would be highly regarded.
  • Recent acute care clinical experience or equivalent.
What Sets You Apart
  • Experience within the Private Health Insurance industry.
  • Extensive knowledge of surgical procedures, terminology and procedural classifications.
  • Experience working in a high dependency/critical care area (ie. ICU, CCU, ED, Theatre) of a private hospital.

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