Business Claims Investigator

9 hours ago

Adelaide, South Australia beBeeEligibility Full time $90,000 - $120,000

Eligibility Officer Role

This is a challenging and rewarding occupation where you will have a positive impact on someone's life every day. You will work closely with your team and relevant stakeholders to investigate, strategize, track, follow-up and determine complex claims.

  • Investigate and assess claims to determine liability.
  • Request information required to assist in the liability assessment process and follow up.
  • Proactively manage claim determinations for complex claims, ensuring clear documentation of actions throughout the determination process.
  • Provide accurate and complete information that is consistent and easy to understand (including options about any claim, entitlements, obligations & responsibilities).
  • Liaise effectively with third parties, i.e. solicitors, IMEs and investigators.
  • Collaborate with case managers / claims specialists and other technical and support experts to manage a portfolio of claims.
  • Ensure the effective management of key legislative drivers in accordance with the Act.

The ideal candidate will have strong customer service skills, effective oral and written communication skills, attention to detail and organizational skills. They will also have the ability to work within a service environment and have experience using our claims management system, Curam, and our recordkeeping system HPE Content Manager (HPCM) would be highly appreciated but not essential.

We offer a vibrant, collaborative and innovative team culture, flexibility with opportunity to work from home when fully trained in your role, a corporate wellbeing program with discounted health insurance and gym membership, access to discounts at over 350 retailers through our Rewards Hub program and more.

  • Claims Investigation Specialist

    2 days ago

    Adelaide, South Australia beBeeInvestigator Full time $72,000 - $96,000

    Job Title:Claims InvestigatorJob Description:The role of Claims Investigator requires a highly organized and detail-oriented individual who can manage claims from inception to resolution. You will be responsible for investigating claims, gathering information, and making informed decisions regarding claim outcomes.As a Claims Investigator, you will work...

  • Medical Claims Investigator

    2 days ago

    Adelaide, South Australia beBeeInvestigator Full time $90,000 - $120,000

    Job DescriptionWe are seeking a skilled and detail-oriented medical claims investigator to join our organization. In this role, you will investigate and help determine whether relevant claims are eligible to receive benefits under the provisions of the applicable policy.Main ResponsibilitiesDeliver accurate, timely, and efficient clinical assessments of all...

  • Insurance Claims Investigator

    1 day ago

    Adelaide, South Australia beBeeInvestigator Full time $90,000 - $120,000

    Seeking Investigators for Insurance ClaimsWe are looking for experienced investigators to join our team.This role offers a unique opportunity for variety and autonomy over your working day. You will be required to attend various locations, predominantly within the Adelaide metro area with a proportion of work across South Australia as required.You will...

  • Claims Investigation Specialist

    9 hours ago

    Adelaide, South Australia beBeeFraud Full time $104,400 - $143,520

    Investigations Officer Job DescriptionThis is an exciting opportunity to work as an Investigations Officer. We are seeking a skilled and experienced professional to join our team in this role.Responsibilities:Safeguard the integrity of insurance claims operations by detecting, investigating, and preventing fraudulent activities.Case manage all activities...

  • Investigations Officer

    14 hours ago

    Adelaide, South Australia Raa Full time

    **Exciting opportunity to join SA's iconic RAA Insurance**:- **Full-time permanent position based in Mile End**:- **Join a new growing team with a high performing, inclusive and supportive culture**This exciting newly created opportunity will see you be responsible for effectively triaging 'red flag' and/or 'high-risk' claims referred by claims staff or...

  • Healthcare Investigator

    3 days ago

    Adelaide, South Australia Bupa Full time

    **How will I help?**People covered by private health insurance expect their claims to be paid efficiently and promptly. They also expect that their contributions don't go towards people who aren't covered and haven't been paying contributions towards private health insurance as they have. Some people choose health insurance products with certain restrictions...

  • Senior Claims Professional

    2 weeks ago

    Adelaide, South Australia beBeeClaims Full time $100,000 - $150,000

    Join us as a senior claims professional to drive exceptional member outcomes in an exciting full-time opportunity.This role will see you leading the management of member claims and investigations, collaborating with solicitors to support our members, and formulating proactive claims strategies to achieve the best possible results.Managing complex claims and...

  • Senior Claims Professional

    1 week ago

    Adelaide, South Australia beBeeClaims Full time $90,000 - $125,000

    Claims Management RoleJob Description:As a key member of our team, you will be responsible for managing and investigating claims to support our members.Manage and coordinate the investigation of claims to ensure timely and cost-effective resolution.Provide guidance and advice to members on claims procedures and entitlements.Develop and implement effective...

  • Professional Claims Practitioner

    2 days ago

    Adelaide, South Australia beBeeClaims Full time $120,000 - $140,000

    Job Description:A leading medical defence organisation seeks a Senior Claims Manager for a full-time, permanent role. As a practising solicitor, you will manage member claims and investigations, providing guidance and support in the indemnification of claims. A strong understanding of current health and insurance legislation is essential.Key...

  • Claims And Payments Integrity Specialist

    2 days ago

    Adelaide, South Australia beBeeClaims Full time $56,592 - $72,845

    APS5 Claims And Payments OfficerWe are seeking an experienced APS5 Claims and Payments Integrity Officer to join our team in Adelaide. The successful candidate will play a critical role in implementing detective and preventative measures to reduce claims and payments errors, improve compliance, and enhance the overall claims and payments control...