Hospital Claims Auditor

1 day ago

Sydney, New South Wales, Australia Teachers Health Full time $80,000 - $120,000 per year

Hospital Claims Auditor - 12-Month Fixed-Term Contract
You'll be responsible for ensuring that claims submitted by Hospital providers on behalf of members comply with internal fund rules and AHSA contract guidelines.

Using HIBIS and other reporting tools, the role will liaise with contacts at Hospitals to validate flagged claim anomalies, and work with internal claims assessors to educate on processing issues leading to benefit leakage.

What we have to offer?
We at Teachers Health have a lot to offer,

  • Attractive leave benefits
  • Hybrid working model (flex your work/life balance)
  • Subsidised private health insurance
  • Discounts on our products and services
  • Generous employee wellbeing program
  • Easily accessible by public transport

Who are we?
Teachers Health was created by teachers for teachers over 70 years ago and is the only health fund exclusively for the education community. As a not-for-profit health fund, we exist for our members covering the lives of over 400,000 teachers, education staff & their families.

What will you do?

  • Daily review of alerts in claim auditing tool HIBIS. Work within settlement terms to prevent release of payment for claims flagged with billing anomalies. Complete 'stop payment' processes within the system where appropriate.
  • Regular review of HIBIS alerts that have fallen outside of payment settlement terms. Prepare audit batches and liaise with Hospital staff to review anomalies and recover leaked benefits.
  • Liaise with the Clinical Coding Auditor to review clinical scenarios and coding issues flagged through various audit activities.
  • Completion of regular control processes around payment duplication and quality assurance. Provide feedback and recommendations to stakeholders when issues are identified.
  • Complete refund request and payment allocation processes in the system for any recoverable amounts identified across various audit types.
  • Provide ongoing education to claims assessors on processing issues that are identified during various audit activities.
  • Review, develop and update relevant policies and procedures and assist with identifying areas where processes may be streamlined and improved.

What do you need?

  • Experience in claims/benefits assessment within private health insurance, or healthcare billing/revenue assurance roles
  • Strong Microsoft Excel skills
  • High attention to detail and strong organisational/time management skills
  • Excellent written and verbal communication skills
  • Stakeholder management experience
  • General understanding of the Australian healthcare landscape
  • Knowledge of medical terminology
  • Experience with HAMBS or similar systems (desirable)

How do I apply?
Click APPLY NOW to submit your updated CV, along with an optional cover letter or a 60-second introduction video sharing why you'd be a great fit for the role.

Teachers Health values diversity and inclusion and encourages applications from people with diverse backgrounds including First Nations people, people with disability, people from diverse cultural and linguistic backgrounds, and people that identify as LGBTQIA+. Applicants can request an adjustment at any stage during the recruitment process by getting in touch with

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