Payment Integrity Specialist

1 month ago


Sydney, New South Wales, Australia Teachers Health Full time
Job Title: Payment Integrity Specialist

Teachers Health is seeking a skilled Payment Integrity Specialist to join our Benefits Assurance team. As a key member of our team, you will be responsible for conducting audits on providers and members to identify and prevent fraud and benefit leakage.

Key Responsibilities:

  • Conduct audits on providers and members who demonstrate high volume, non-compliant or unusual claiming behaviors.
  • Investigate and audit of providers and member claims flagged by the Ancillary Claims Team.
  • Review provider-related tip-offs from external sources and investigate and assess impact to TH where applicable.
  • Provide recommendations to the Payment Integrity Manager and Provider Relations Officer based on outcomes of various audit activities.
  • Develop and continuously improve Standard Operating Procedures for various audit activities.

Requirements:

  • Knowledge and experience of working in Private Health Insurance.
  • Handling claims.
  • Experience working with large data sets.
  • Keen eye for detail.
  • Inquisitive.
  • A problem solver.

What We Offer:

  • 6 weeks of annual leave.
  • Hybrid working model.
  • Subsidized private health insurance and discounts on our products and services.
  • Fantastic central location in Surry Hills.
  • Employee well-being program.
  • An annual corporate wardrobe allowance.
  • 18 weeks paid parental leave for eligible employees.
  • Additional long service leave.


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