Hospital Claims Manager
4 weeks ago
As a Hospital Claims Manager at Dental Corporation, you will play a critical role in preventing leakage through the reduction of fraud, waste, abuse, and error of hospital and medical claims. You will be responsible for managing the identification, mitigation, elimination, and management of claim inaccuracy and leakage.
Key Responsibilities:- Manage a team of auditors across hospital and medical utilization, DRG audits, and desktop audits within an agreed annual work program.
- Lead the management of provider onsite audits, manage end-to-end processes, including follow-up and financial management of incorrect billing.
- Work closely with prosthesis integrity, hospital, and medical contracting teams to ensure we maximize leverage of contracting terms and identify new areas of actual and potential claims leakage.
- Manage the process to review individual hospital and medical claims to advise where there are incorrect, inappropriate, or servicing practices, and instigate recoveries.
- Negotiate financial recoveries from hospital and medical providers and keep aged debt to a minimum.
- In conjunction with the Head of Claims Integrity, develop claims leakage strategies aligned with our focus areas (including prevention) to support the meeting of financial targets.
- Monitor utilization trends across the industry, providing insight to relevant stakeholders through participation in industry group forums.
- Degree qualified in Finance, Commerce, or an area of Healthcare (e.g., Nursing, Physiotherapy, Healthcare Informatics, etc.). Clinical experience highly regarded.
- Mid-level management experience leading a large team, operating either in health insurance or healthcare.
- High-level knowledge of private and public health.
- Worked within a large, complex environment with multiple legacy systems.
- Ability to work collaboratively and effectively influence a diverse range of stakeholders.
- Experience building and developing a high-performing team of diverse skill sets.
Dental Corporation is an international healthcare group committed to helping people live longer, healthier, happier lives and making a better world for more than 70 years. We operate in Australia, New Zealand, and Hong Kong, supporting about 6.5 million customers through a broad range of health and care services, including health insurance, aged care, dental, medical, optical, and hearing services.
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Hospital Claims Manager
2 weeks ago
Melbourne, Victoria, Australia Dental Corporation Full timeJob Title: Hospital Claims ManagerAs a Hospital Claims Manager, you will be responsible for managing the identification, mitigation, elimination, and management of claim inaccuracy and leakage in hospital and medical claims. You will lead a team of auditors and work closely with prosthesis integrity, hospital, and medical contracting teams to ensure maximum...
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Hospital Claims Manager
2 months ago
Melbourne, Victoria, Australia Dental Corporation Full timeJob Title: Hospital Claims ManagerWe are seeking an experienced Hospital Claims Manager to join our team at Dental Corporation. As a key member of our healthcare operations team, you will be responsible for managing the identification, mitigation, elimination, and management of claim inaccuracy and leakage in hospital and medical claims.Key...
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Hospital Claims Manager
1 week ago
Melbourne, Victoria, Australia Dental Corporation Full timeHospital Claims Manager Job DescriptionAs a Hospital Claims Manager at Dental Corporation, you will play a critical role in preventing leakage through the reduction of fraud, waste, abuse, and error of hospital and medical claims. You will be responsible for managing the identification, mitigation, elimination, and management of claim inaccuracy and leakage....
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Hospital Claims Manager
5 days ago
Melbourne, Victoria, Australia Dental Corporation Full timeJob DescriptionRole SummaryThe Hospital Claims Manager will be responsible for managing the identification, mitigation, elimination, and management of claim inaccuracy and leakage in hospital and medical claims. This role demands a strong leader in the field of Private Health Insurance or from a Hospital Setting who has demonstrated the ability to take...
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Hospital Manager – Healthcare Integrity Specialist
2 months ago
Melbourne, Victoria, Australia Dental Corporation Full timeAbout the RoleWe are seeking a highly skilled and experienced Hospital Manager to join our team at Dental Corporation. As a key member of our healthcare team, you will be responsible for leading the identification, mitigation, elimination, and management of claim inaccuracy and leakage in hospital and medical claims.Key ResponsibilitiesManage a team of...
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Hospital Manager – Healthcare Integrity Specialist
2 months ago
Melbourne, Victoria, Australia Dental Corporation Full timeAbout the RoleWe are seeking an experienced and skilled Hospital Manager – Healthcare Integrity Specialist to join our team at Dental Corporation. As a key member of our organization, you will play a critical role in preventing leakage through the reduction of fraud, waste, abuse, and error of hospital and medical claims.Key ResponsibilitiesManage a Team...
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