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Healthcare Investigator

2 weeks ago

Adelaide Region SA, 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 on what might be covered. It’s not always straightforward.

You will investigate and help determine whether relevant claims are eligible to receive benefits under the provisions of the level of cover held by the member. To do so you will use the knowledge of health insurance products you will gain in our team, your inquisitive mind and your powers of deduction. Senior people in the team and doctors working with us can help you come to decisions and make recommendations fairly and with proper regard to our members’ rights and expectations.
- This position may be based in Adelaide, Brisbane, Melbourne or Sydney._

**Key accountabilities include**:

- Be a team player. Drive positive cultural change. Align your behaviours with current and future business objectives.
- Deliver accurate, timely and efficient clinical assessment of all assigned claims.
- Communicate with our customers with consideration, empathy, and proper respect for people who are experiencing health and financial pressures. The same professional approach is to be applied to communication with health care practitioners, providers and other relevant stakeholders.
- Identify and recommend opportunities for process and functional improvements that support this review.

**What’s in it for me?**

The opportunity to work within a high profile, industry leading global health insurer, where your contribution makes a difference. Bupa operates in 6 continents and offers a range of services, including health insurance. If you enjoy solving puzzles and have the capacity to examine complex information to find relevant facts, these roles may be what you’re looking for.

**Perk highlights**:

- Subsidised health insurance as well as discounts when you attend a Bupa Dental clinic or purchase glasses from a Bupa Optical store.
- A dedicated internal wellbeing team provides you with a range of services, such as a global resilience program, regular training opportunities on a range of wellbeing topics and access to a variety of wellbeing discounts.

**What do I need?**

This position may suit someone with experience or an interest in investigating and reviewing claims within a framework of policies and legislation.
- Solution-focused to identify a fair assessment for our customers claims in accordance with policy rules
- Learns and retains new skills and information easily
- Self-starter, enjoy learning new systems, processes and comfortable in navigating legislation to ensure compliance
- Very good written and verbal communication skills to engage in professional conversations with customers and providers
- Familiarity with Customer Relationship Management systems is an advantage but not essential
- Competent in using MS Office suite with advanced data entry skills
- Previous experience working in insurance or healthcare industries would be advantageous but not essential