Clinical Integrity Specialist

1 week ago

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

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.
  • Developing and applying system rules to flag high-risk claims before payment.
  • 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?

Great Applying is as simple and quick as clicking on the "Apply Now" button to complete your application.

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

At HBF, we don't just accept difference - we celebrate it, we support it, and we thrive on it for the benefit of our employees, our products, and our community. HBF is a place of belonging. We are proud of who we are, and we encourage applications from diverse groups such as Indigenous and Torres Strait Islander people, physical ability, age, sexual orientation, gender identity or expression and family background, including caring responsibilities.

  • clinical integrity specialist

    1 week 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 Nurse Specialist

    1 week ago

    Perth, Western Australia North Metropolitan Health Service Full time $100,000 - $120,000 per year

    Do you want to be a part of a team that promotes and improves the health of its people and community?We are seeking suitable applications for a highly capable and values-driven Clinical Nurse Specialist to join our dynamic team at Mirrabooka Community Adult Mental Health.This is for a Permanent Full Time appointment.What is our Clinical Nurse Specialist...

  • Integration Specialist

    1 week 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...

  • NDIS Specialist Support Coordinator

    1 week 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 week ago

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

    Clinical Documentation SpecialistIf you're venturing into a new career but still aspire to contribute significantly to patient care, dive into a realm of a Clinical Documentation Specialist.2 temporary part time positions (70 hours and 64 Hours) - Opportunity for flexible hours for better work life balance4 to 5 days a week and 10 month durationAbout the...

  • Practice Manager

    4 weeks ago

    Perth, Western Australia Veritas Specialist Centre Full time

    Practice Manager - Medical Specialist CentreJob Title: Practice Manager – Multi-Disciplinary Bariatric and General Surgery PracticeEmployment Type: Full-timeAbout Us: We are a leading multi-disciplinary bariatric and general surgical practice committed to delivering exceptional patient care through a collaborative team approach. Our practice integrates...

  • Procurement and Contracts Specialists

    6 days ago

    Perth, Western Australia Integrity Executive Full time $104,000 - $130,878 per year

    Integrity is a West Australian owned and operated recruitment and staffing agency, with over 20 years' experience in the WA marketplace. We provide permanent and temporary recruitment solutions, as well as HR services and consultancy to the WA State Government, Local Government,Not-for-Profit Sector and the  Private Industry throughout WAWe are seeking a...

  • Clinical Specialist

    1 week ago

    Perth, Western Australia Boston Scientific Full time $80,000 - $120,000 per year

    Hiring Manager: Chantal De WinterRecruiter: Aislinn RocheABOUT THE ROLEOur elite sales team is made up of passionate, dedicated professionals, delivering the most advanced medical technologies to patients in need. By collaborating extensively with leading healthcare professionals you'll see first-hand the impact you have on individual lives - one patient at...

  • Clinical Nurse Specialist

    1 week ago

    Perth, Western Australia St John of God Health Care Inc Full time $120,000 - $150,000 per year

    Welcome to St John of God Health Care St John of God Health Care is one of the largest private providers of health care services in Australia, employing more than 16,000 employees (caregivers). We operate 26 hospitals and services comprising more than 3,300 hospital beds, including home nursing, disability services and social outreach programs. St John of...

  • Clinical Support Specialist

    3 weeks ago

    Perth, Western Australia LifeHealthcare Full time

    Clinical Support Specialist - Abdo-Pelvic and Neurosurgery - AUJoin to apply for the Clinical Support Specialist - Abdo-Pelvic and Neurosurgery - AU role at LifeHealthcareLifeHealthcare is a leading independent distributor of medical devices. This part-time role is 3 days per week on an 8-month contract and involves managing clinical cases in hospitals and...