Clinical Integrity Specialist

2 days ago

Greater Perth Area, Australia HBF Health 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.

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