Clinical Integrity Specialist

3 days ago

Perth, Australia HBF Health Full time

**Job no**: 494380
**Work type**: Permanent full time
**Location**: Perth CBD
**Categories**: Health Services

**HBF Employee Benefits**
- FREE Corporate Gold Hospital Insurance (for you and your family)
- 3 additional wellbeing days off a year (on top of our standard 20 days annual leave and 10 days personal leave) pro rata
- 2 volunteering days per year
- 18 weeks paid parental leave
- Access to corporate discounts across a range of gyms, retail, restaurants, and hotels

**About the Role**
The Clinical Integrity Specialist helps support HBF’s strategic goals by reviewing hospital claims to assess their accuracy and compliance with contracts, regulations, and industry standards. Where needed, they’ll also initiate recovery of any benefits that have been incorrectly paid.

This role calls for a qualified Registered Nurse to spot clinical anomalies in hospital claims and ensure they align with relevant legislation and agreements.

The key responsibilities of this role include:

- Reviewing hospital and medical claims to ensure compliance with regulations, contracts, and industry standards.
- Investigating clinical claims and medical records to confirm accuracy and member eligibility.
- Identifying claim anomalies, reduce financial loss, and support benefit recovery efforts.
- Building and maintaining professional relationships with healthcare providers during investigations.
- Maintaining clear, compliant procedures for clinical claim assessment.
- Providing clinical expertise and training to internal teams and external stakeholders.
- Contributing to performance reporting, audits, and strategic projects.

**About You**
We are looking for someone who has come from a clinical background and has had experience being a primary decision maker, ideally in management roles.

Ideally, you will have:

- A degree in Nursing, with extensive post-graduate or equivalent experience
- Experience within a wide range of clinical specialties
- Excellent written and verbal communication skills, including report writing and presentation delivery.
- Strong interpersonal skills with the ability to build relationships, influence stakeholders, and handle sensitive situations with empathy.
- Solid analytical skills, including proficiency in Microsoft Excel.
- Ability to explain clinical concepts clearly to non-clinical audiences.
- Knowledge of the private health insurance industry, including hospital invoicing and claiming processes (prior experience in health insurance or as a Nurse Unit Manager is highly regarded).

**Does this sound like you?**

Our recruitment and selection process includes a variety of assessment methods including reference checks, National Police Clearance and verification of working rights in Australia.

**Advertised**: 28 Aug 2025 W. Australia Standard Time
**Applications close**: 12 Sep 2025 W. Australia Standard Time

  • Clinical Integrity Specialist

    5 days ago

    Perth, Western Australia HBF Health Limited Full time $90,000 - $120,000 per year

    HBF Employee BenefitsFREE Corporate Gold Hospital Insurance (for you and your family)3 additional wellbeing days off a year (on top of our standard 20 days annual leave and 10 days personal leave) pro rata2 volunteering days per year18 weeks paid parental leaveAccess to corporate discounts across a range of gyms, retail, restaurants, and hotelsAbout the Role...

  • clinical integrity specialist

    3 days ago

    Perth, Western Australia HBF Health Full time $90,000 - $120,000 per year

    Job no: 494380Work type: Permanent full timeLocation: Perth CBDCategories: Health ServicesHBF Employee BenefitsFREE Corporate Gold Hospital Insurance (for you and your family)3 additional wellbeing days off a year (on top of our standard 20 days annual leave and 10 days personal leave) pro rata2 volunteering days per year18 weeks paid parental leaveAccess to...

  • Clinical Integrity Specialist

    5 days ago

    Greater Perth Area, Australia HBF Health Full time $90,000 - $120,000 per year

    HBF Employee BenefitsFREE Corporate Gold Hospital Insurance (for you and your family)3 additional wellbeing days off a year (on top of our standard 20 days annual leave and 10 days personal leave) pro rata2 volunteering days per year18 weeks paid parental leaveAccess to corporate discounts across a range of gyms, retail, restaurants, and hotelsAbout The...

  • Clinical Case Manager

    1 week ago

    Perth, Western Australia Specialist Support Coordination Services Full time $90,000 - $120,000 per year

    Company DescriptionSpecialist Support Coordination Services (SSCS) provides high-quality, person-centred support coordination for NDIS participants with complex needs across WA. We specialise in Level 3 Specialist Support Coordination, managing cases involving the justice system, hospital or care transitions, mental health challenges, and housing...

  • Clinical Quality Specialist

    7 days ago

    Perth, Australia HAYS Full time

    Quality and Compliance Accreditation Specialist in Aged care **Your new company** We are working with a leading Aged Care and Retirement provider based in Western Australia. With over 70 years of experience this organisation works across multiple services to provide the best supports within the Aged care sector. **Your new role** We are seeking a...

  • Integration Specialist

    3 days ago

    Perth, Western Australia St John of God Health Care Full time $124,196 - $137,946 per year

    Your role at St John of God Health CareAs our IT landscape continues to evolve, seamless integration between applications and systems is essential to delivering efficient and scalable digital solutions. The Integration Specialist (MuleSoft) plays a critical role in the development, customisation, configuration, support, and maintenance of hospital and...

  • Specialist Clinical Pharmacist

    3 weeks ago

    Perth, Australia NHS Full time

    Specialist Clinical Pharmacist - Clinical & High-cost Medicine An opportunity has arisen for a motivated clinical pharmacist who wish to develop specialist knowledge and skills in high-cost drugs provision across various clinical specialties. You will support the Principal Pharmacist - High-cost drugs in ensuring cost-effective use of this group of...

  • Integration Specialist

    1 week ago

    Perth, Australia Peoplebank Full time

    Location: - Perth CBD- Job Type: - Contract- Posted: - 11 minutes ago- Contact: - Alson Fernandes- Discipline: - General IT - Reference: - 261114**Integration Specialist** **Position Title** - Initial 12month contract with a leading university - Seeking experience with SQL DBA and ETL tools - Flexible working arrangements **About the company**: Our client...

  • NDIS Specialist Support Coordinator

    3 days ago

    Perth, Western Australia Specialist Support Coordination Services Full time $60,000 - $80,000 per year

    Position Available:NDIS Specialist Support CoordinatorAre you a Physiotherapist, Occupational Therapist or Registered Nurse seeking a change in pace? Looking to step away from the treatment room but still make a meaningful impact? Join our team as a Specialist Support Coordinator / Clinical Case Manager and take your career in an exciting new directionSSCS...

  • Clinical Documentation Specialist

    1 day ago

    Perth, Australia Ramsay Health Care Full time

    **Clinical Documentation Specialist** **Hollywood Private Hospital, Nedlands** **An exciting opportunity for permanent full time and part positions are available for nurses who are seeking a new challenge or wishing to build upon their existing knowledge of Clinical Documentation Improvement.** - _Flexibility of working between 0700 and 1530 Monday to...