Expert Claims Specialist
2 days ago
At our organization, we strive to provide exceptional wellbeing services to our community. We're currently seeking a highly skilled Clinical Claims Specialist to join our team.
The successful candidate will play a vital role in ensuring the accuracy and legitimacy of health insurance claims, while maintaining compliance with relevant regulations.
This is an excellent opportunity for a registered nurse to leverage their expertise and make a meaningful contribution to our organization's mission.
About the RoleWe're looking for a motivated and detail-oriented individual who can assess claim information based on current disease management principles and evidence-based surgical pathways.
- Provide expert clinical assessments and document outcomes in Salesforce/Ensure with appropriate rationale.
- Assist the Compensation & Analysis team with complex pre-existing condition assessments and medical reports as required.
- Engage with the Hospital Assessing Team to transfer skills, knowledge, and insights to ensure integrity of hospital claims assessment processes.
- Contribute to guiding principles to ensure evidence-based decision making remains up-to-date with current trends and technology.
To be successful in this role, you'll need:
- Bachelor of Health Science in Nursing and current registration with AHPRA as a Registered Nurse.
- Relevant post-graduate qualification highly regarded.
- Recent acute care clinical experience or equivalent.
- Understanding of MBS, DRGs, Government legislation and regulations particularly the Private Health Insurance Act 2007.
You'll enjoy a range of benefits, including:
- Competitive salary and bonus program.
- Additional yearly wellbeing and community leave days.
- 14-week paid parental leave with equal benefit for both parents.
- Employee referral program.
- Employee assistance program.
- Maxxia rewards.
We're committed to creating a diverse and inclusive workplace culture that values employee wellbeing and development.
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