Quality Review Officer

3 days ago

Sydney Central Business District, Australia HCF Full time

**About HCF**

At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we’ve been putting our members and their health first. As Australia’s largest not-for-profit health fund, we cover over 1.7 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member centric.

**About the Role**:
The Quality Review Officer will be responsible for reviewing and auditing all types of claims and procedures to ensure accuracy of payments.

**Please note this position is a 12 month max term contract.**

Key responsibilities will include
- Identifying and reporting on opportunities for improvement and refer to Team Leader
- Identifying potential fraud and refer to Investigations area for further review
- Ensuring claims reviewed are paid in accordance with Fund Rules
- Maintaining claims quality by ensuring processing accuracy targets are achieved and error rates are below unit KPI’s
- Providing reporting for Claims Operations management team on a monthly basis depicting audits conducted, issues identified and recommendations
- Recording and following up on issues identified until resolution
- Completing ad hoc tasks as requested

**To be successful in this role, you will have**:

- Strong knowledge of all claims systems and processes
- Sound knowledge of all HCF Group’s products and procedures and Fund Rules
- Strong Microsoft office skills, including Excel, Word and PowerPoint
- Proven analytical, problem solving and reporting capabilities
- Prior experience in dealing with various stakeholders
- Good interpersonal and communication skills with ability to recommend and influence decisions
- Self-motivated with strong teamwork skills
- Ability to operate effectively in a dynamic business environment and in areas where substantial change is required
- Ability to identify opportunities to enhance unit productivity and accuracy of claims payment
- Ability to communicate effectively verbally and in writing to both internal and external customers and provide feedback on reviews conducted

**Culture**

Working in the health insurance industry, we know how important it is to prioritise the wellbeing of our own people. We want to provide you with the skills and tools you need to support your wellbeing journey, so that you can be at your best.

We’re all about creating a fantastic people experience, guided by our values, so that we can in turn better deliver for our members. We work with our people to create a work experience that is inclusive, supportive, safe and respectful so we can do the best for our members.

Come and join our HCF team

**Benefits**
- 50% off on Private Health cover, discounted pet and travel insurance
- Organisational-wide Recognition & Rewards program
- Generous Parental Leave Scheme
- Health and Wellbeing Initiatives
- Additional Family & Friends day

**A career with us - How to Apply

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