Head of Hospital and Medical Audit

A career at Bupa is more than just a job. It’s an opportunity to make a real difference in the lives of our customers and communities. Our purpose, helping people live longer, healthier, happier lives and making a better world, is what inspires us.

**The opportunity**

As the
**Head of Hospital and Medical Audit**, your key focus is to prevent benefit leakage through the reduction of fraud, waste, abuse and error of private health insurance claims. You’ll deliver this via programs of work which are developed through the Claims Integrity roadmap, leveraging process, system and advanced analytics to operate more effectively.

There is a significant requirement to support uplift in systems implementation and analytics adoption to drive improved ROI.
- This is a full-time permanent position and may be based at our Melbourne offices when you are not working from home. (Bupa offers hybrid working and you can work from the office or at home)_

**How will I help?**
- Build a collaborative culture, leveraging cross-functional capability to solve problems within the broader Health Insurance team and across the business
- Oversee hospital, clinical provider, member profiling reviews within an agreed annual work program
- Act as business lead for the adoption of Advanced analytics approaches to improve detection and reduce manual processing across all audit areas.
- Oversee the management of provider onsite audits, manage end to end processes including follow up and financial management of incorrect billing.
- Work closely with Hospital Contracting team to ensure maximise leverage of contracting terms and identify new areas of actual and potential claims leakage.
- Manage the process to review individual hospital and medical claims eg Critical Care certification, Prosthesis billing and Gap Scheme, etc to advise where there is incorrect, inappropriate or servicing practices, and instigate recoveries
- Lead teams of auditor across Hospital, Prosthesis and Medical Claiming to ensure quality in everything that we do.

**What’s in it for me?**

As well as a competitive salary, a range of Bupa benefits and flexible working/ work from home arrangements, you’ll be challenged and encouraged to innovate. You will partner with colleagues who are dedicated to delivering exceptional experiences. We respect and consider everyone, knowing your difference will make the difference.

**Perk highlights**:

- Discount on our health insurance, travel, car, home, contents and pet insurance products 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 role may suit a senior people leader who has delivered business transformation activities or implemented a payment integrity system.
- Degree qualified in Finance, Commerce or an area of Healthcare (e.g. Nursing, Physiotherapy, Healthcare Informatics etc)
- Senior level management experience leading a large team, operating either in a Private Health Insurer, Healthcare company or a service-based industry.
- Adept in working within a large, complex environment with multiple legacy systems.
- Experience in leading teams to drive commercial outcomes and the sharing of insights with data and a strong narrative.
- Experience in successfully partnering across functions in the development and implementation of strategies to deliver commercial outcomes within complex, matrix organisations.
- Strong written and presentation skills and the ability to convert data into insight and prepare compelling, persuasive reports and presentations.

**About Bupa Asia Pacific**

Bupa is an international healthcare group which has been committed to a purpose of helping people live longer, healthier, happier lives and making a better world for more than 70 years.

Bupa Asia Pacific operates in Australia, New Zealand and Hong Kong, supporting about 6.5 million customers through a broad range of health and care services including health insurance, aged care, dental, medical, optical and hearing services.

Employing more than 20,000 people in the region, we believe that we can make a real difference to the lives of customers through our values, purpose and the way that we deliver personalised care. Since 2002, we have reinvested approximately $6 billion in the region, with the Bupa Foundation investing more than $34 million to support 130+ health and care projects. Our people reflect the diversity of our community. At Bupa, your wellbeing, identity and own story is respected and valued.