Healthcare Insurance Claims Specialist

1 day ago

Melbourne, Victoria, Australia beBeeClinicalClaimsSpecialist Full time $100,000 - $120,000
Clinical Claims Analyst Role

We seek a skilled registered nurse to fill this clinical claims analyst position within our health insurance business.

This role plays a key part in ensuring the accuracy, legitimacy, and compliance of health insurance claims and clinical applications.

Main Responsibilities:
  • Provide expert clinical assessment of claim information based on current disease management principles and an understanding of evidence-based surgical and clinical pathways
  • Document clinical assessment outcomes in Salesforce with appropriate rationale for decisions to ensure transparency in decision making
  • Assist the compensation team with complex pre-existing condition assessments, medical reports, and accident analysis
Essential Requirements:
  • Registered Nurse with experience in critical care (ICU, operating theatre or ED) and/or private healthcare
  • Extensive knowledge of surgical procedures and associated clinical pathways
  • Ability to provide insights and support to stakeholders involved in claims analysis, provider relations, and quality assurance

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