Clinical Adviser

BE THE DIFFERENCE
At AIA we don’t simply believe in being ‘the best’. We believe in better - because there’s no limit to how far ‘better’ can take us. Everything we do is driven by our purpose to make a difference by helping people embrace Healthier, Longer, Better Lives. And every one of our people has an important role to play. If you want to make a difference by helping shape a healthier, better-protected Australia, read on.

The opportunity:
AIA has a fantastic opportunity for a Clinical Adviser & Claims Auditor to join our Health Insurance team based in Melbourne, on a 12-month max term contract.

As the Clinical Adviser & Claims Auditor, you will measure and test procedures with an eye to improving overall efficiency, drive the improvement of processes and systems, quality focus, and implement programs that will have continuing long-term benefits.

The successful applicant will also ensure the ongoing and productive auditing of hospital, medical and ancillary claims as required by the business, and as determined through the annual review of identified savings targets.

To do this successfully you will:
- Complete clinical advice & claims auditing supporting the claims department and assessors, driving continuous improvement of processes and systems, ensuring accuracy and compliance- Ensure audits conducted are compliant with PHI Rules, Contract Agreements and Schedules, HICAPS Terms and Conditions, Fund Rules and other policy requirements of the business- Assist the Customer Service Team Managers in implementing policies, procedures, guidelines and audit schedules- Contribute to AIA overall claims leakage strategic plan and objectives through planning own work and timely attendance to all delegated tasks and functions.- Consider problems or issues that may arise and use lateral thinking to resolve or recommend solutions.- Provide clinical advice to assessors and business where required.- Liaise with hospital and provider billing teams as required to undertake the audit function effectively- Experience working with PHI Hospital and Ancillary claim data- Successful completion of recognised Medical Terminology course- Coding experience with knowledge of ICD-10-AM (11th edition), ACHI & ACS- Knowledge of private sector funding models- Degree Qualification in Health Information Management (HIM) will be highly regarded- Able to read and understand claims data and medical records with the ability to determine where inconsistencies and/or outliers have occurred.- Excellent organizational and time management skills, including demonstrated experience in coordinating input from a number of contributors- Effective consulting and stakeholder management skills

Why choose AIA:
At AIA, we’ve made a promise to help people live healthier, longer, better lives. And it starts with our own people.- Access our training and development to build on your current skills- Career development through internal mobility opportunities- Work for a business helping millions of Australians and make a difference to someone’s life everyday- Access additional leave days a year to recharge and refresh yourself- Enjoy wonderful Health and Wellbeing initiatives that support you- Work with supportive and inclusive managers

At AIA Australia, we’re proud to help guide, support and protect the wellbeing of over 3.5 million Australians. As part of the AIA Group - the largest independent publicly listed pan-Asian life insurance group - it is our ambition to engage one billion people to live Healthier, Longer, Better Lives by 2030.

Lots of companies like to say they’re different. What makes us truly different at AIA, is the difference we make in people’s lives. We are proud that this difference has been recognised in the 2024 ANZIIF awards by being named Life Insurance Company of the Year

AIA is different. Are you?