Hospital Claims Specialist

4 days ago

Sydney, New South Wales, Australia Avant Full time $60,000 - $90,000 per year

About Doctors Health Fund:

Doctors' Health Fund is a leading provider of private health insurance exclusively for the medical community across Australia. As part of the Avant Mutual Group, we proudly support over 70,000 healthcare professionals, students, and their families. Our commitment to members is at the heart of everything we do - driven by our values, mission, and people-first culture.

About the Role:

We are seeking a Hospital Claims Specialist to join our Claims & Business Operations team. In this role, you will be responsible for accurately assessing and processing hospital claims in line with Doctors Health Fund rules, policies and procedures while delivering exceptional service to our members, providers, and third-party organisations. This role involves some inbound and outbound phone contact, providing clear and timely communication, and identifying opportunities to improve processes. You will play a key part in ensuring service expectations are consistently met in a high-volume environment.

Key Accountabilities:

  • Accurately assess claims in accordance with Doctors Health Fund Rules, policies, procedures, and legislative requirements, within service level agreements.
  • Handle inbound and outbound calls, ensuring timely, accurate and professional communication with members, providers, and third parties.
  • Maintain comprehensive knowledge of systems and products.
  • Deliver clear, professional, and respectful written and verbal communication with internal and external stakeholders.
  • Work towards individual and team KPIs, take ownership of outcomes, and share knowledge with peers to drive success.
  • Ensure adherence to privacy, APRA, PHI Act, and WH&S requirements.
  • Support staff development by creating training materials, delivering training sessions and maintaining accurate training records.

To be Successful you will have:

  • 3+ years experience in same/similar Senior Hospital Claims Assessor role.
  • HSC or equivalent preferred.
  • Customer service background.
  • Insurance or health industry experience.
  • Data entry and administrative experience.
  • Strong decision-making and problem-solving ability.
  • Excellent written and verbal communication.
  • High attention to detail with strong organisational skills.
  • Proficiency in computer systems and ability to adapt to new technology.
  • The ability to work collaboratively and contribute as a strong team player.
  • Results-driven mindset.

Equal Opportunity Employer

Avant supports doctors so they can serve Australia's diverse communities. Having diversity in our workforce brings valuable perspectives and strengthens our ability to support healthcare professionals.

We therefore welcome applications from people of all backgrounds, including Aboriginal and Torres Strait Islander peoples, people from culturally diverse communities, LGBTQIA+ individuals, people with disabilities, and those with caring responsibilities.

Our inclusive workplace is somewhere everyone can succeed.

Ready to join us? If you're passionate about supporting Australia's healthcare professionals, we'd love to hear from you. If you require any adjustments during the recruitment process, please don't hesitate to contact us

  • Hospital Claims Specialist

    4 weeks ago

    Sydney, New South Wales, Australia Avant Mutual Full time

    About Doctors Health FundDoctors' Health Fund is a leading provider of private health insurance exclusively for the medical community across Australia. As part of the Avant Mutual Group, we proudly support over 70,000 healthcare professionals, students, and their families. Our commitment to members is at the heart of everything we do - driven by our values,...

  • Hospital Claims Specialist

    4 weeks ago

    Sydney, New South Wales, Australia Avant Mutual Full time

    About Doctors Health FundDoctors' Health Fund is a leading provider of private health insurance exclusively for the medical community across Australia. As part of the Avant Mutual Group, we proudly support over 70,000 healthcare professionals, students, and their families. Our commitment to members is at the heart of everything we do - driven by our values,...

  • Motor Claims Consultant

    2 weeks ago

    Sydney, New South Wales, Australia Advent Claims Australia PL Full time $537,777 - $8,914,163 per year

    About UsAdvent Claims Australia is a trusted Third Party Authority (TPA) representing one of the world's leading vehicle fleet organisations. As we enter an exciting growth phase, we are seeking a motivated and experienced Motor Recovery / Settlements Specialist to join our friendly, professional team in Sydney's CBD.What We OfferCompetitive remuneration...

  • Hospital Claims Auditor

    12 hours ago

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

    Hospital Claims Auditor - 12-Month Fixed-Term ContractYou'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...

  • Claims Specialist

    4 days ago

    Sydney, New South Wales, Australia KPMG Australia Full time $90,000 - $120,000 per year

    Claims Specialist - Claims and Workplace Health We help personal injury insurers and schemes, life insurers, general insurers, self-insurers and employers, navigate complex business issues, drive change and implement solutions that enhances performance. Your opportunity KPMG's Insurance Claims and Workplace Health practice is seeking an experienced claims...

  • Senior Claims Specialist

    4 weeks ago

    Sydney, New South Wales, Australia Suncorp Group Full time

    Senior Claims Specialist – High Value and Complex ClaimsJoin to apply for the Senior Claims Specialist – High Value and Complex Claims role at Suncorp GroupSenior Claims Specialist – High Value and Complex Claims1 day ago Be among the first 25 applicantsJoin to apply for the Senior Claims Specialist – High Value and Complex Claims role at Suncorp...

  • Claims Specialist

    4 weeks ago

    Sydney, New South Wales, Australia Howden Group Full time

    Claims Specialist page is loaded## Claims Specialistlocations: Sydney - LV 29, Angel Placetime type: Full timeposted on: Posted Todayjob requisition id: R0013971**About DUAL**Driven by a vision to be the world's best underwriting business, DUAL has always taken a different approach to our industry peers.Since our business was founded in 2004, we have...

  • Claims Specialist

    4 weeks ago

    Sydney, New South Wales, Australia Howden Group Full time

    Claims Specialist page is loaded## Claims Specialistlocations: Sydney - LV 29, Angel Placetime type: Full timeposted on: Posted Todayjob requisition id: R0013971**About DUAL**Driven by a vision to be the world's best underwriting business, DUAL has always taken a different approach to our industry peers.Since our business was founded in 2004, we have...

  • Claims Specialist

    3 weeks ago

    Sydney, New South Wales, Australia DUAL Australia Full time

    OverviewJoin to apply for the Claims Specialist role at DUAL Australia.Driven by a vision to be the world's best underwriting business, DUAL has always taken a different approach to our industry peers. Since our business was founded in 2004, we have had a strong entrepreneurial spirit that runs through every part of our business. We empower our people to...

  • Claims Specialist

    3 weeks ago

    Sydney, New South Wales, Australia DUAL Australia Full time

    OverviewJoin to apply for the Claims Specialist role at DUAL Australia.Driven by a vision to be the world's best underwriting business, DUAL has always taken a different approach to our industry peers. Since our business was founded in 2004, we have had a strong entrepreneurial spirit that runs through every part of our business. We empower our people to...