Aps 5 Claims and Payments Integrity Officer

4 days ago

Gold Coast, Australia HAYS Full time

APS5 Claims and Payment integrity officer | Federal Government agency

Hays is recruiting APS5 Claims and Payment integrity officer for a Federal Government agency based in Robina, for a 12-month assignment (with potential extension options).

The APS5 Claims and Payments Integrity Officer will have a considerable level of public contact in relation to complex, difficult or sensitive issues. It may liaise with a range of internal and external stakeholders in a representational role on behalf of the branch/division/NDIA.

Responsibilities may include but are not limited to:

- Undertaking control and conformance testing and providing administrative support for the PPC and SMP Programs.
- Providing input to appropriate assurance and compliance reports to articulate outcomes of reviews and actions required, including delivering compliance decisions to participants and providers.
- Modifying test documentation (Test Guides and Test Forms) to ensure assurance of program relevancy.
- Undertaking reviews of targeted claims through engagement with providers, plan managers and participants.
- Contributing to the design of new detective and preventative controls using a combination of manual validation check and systematic analytics.
- Working with various teams to investigate, report on and escalate claims and payments anomalies.

Key skills/experience required:

- Applies judgement, intelligence, and common sense.
- Communicate clearly and concisely.
- Applies and builds appropriate knowledge, skills, and experience.
- Adapts to, supports, and manages change.
- Effectively manages time and resources to ensure that work is completed efficiently.

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