Payment Integrity Specialist
1 month ago
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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