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Hospital Claims Officer
4 months ago
About the Role
As a Medical Claims Officer, you will be responsible for processing high volume medical claims. This role has a strong customer service focus, and it is essential that accurate information and exceptional service in provided responding to enquiries raised by internal customers, members, Medicare Australia and providers. A thorough understanding of the funds policies and procedures are required. This role is a max term position for 12 months.
Responsibilities:
Key responsibilities will include:
- Assess and review all types of medical claims
- Review and pay medical claims in accordance with Fund Rules and policies
- Maintain claims quality by ensuring processing accuracy targets are achieved and error rates are below unit KPI’s
- Registering Medicover providers and updating provider details, maintain medical provider records and contract details
- Processing of No Gap & Known Gap Medical claims using “PreMac” User interface
- Process rejected, refused, suspended and adjusted claims, using WHICS system
- Maintain medical provider records and contract details
- Perform medical claims adjustments and initiate follow up/recovery action as required
- Action reports and perform quality review processes as required
- Proactively respond to enquiries from Medicare Australia and providers.
About You
You will have strong customer service skills and previous experience within claims, call centre or administration roles.
- Intermediate PC skills with accurate data entry skills
- Ability to adapt positively to changing work practices and needs
- Proficient understanding of WHICS, ECLIPSE, “PreMac” especially in relation to reassessments and claims processing
- Ability to set own priorities to ensure individual and team targets are achieved / exceeded
- Ability to communicate verbally effectively and courteously and in writing to both internal and external customers
- Ability to work autonomously and set own priorities to ensure unit objectives are met.
About HCF
At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we’ve been putting our members and their health first. As Australia’s largest not-for-profit health fund, we cover over 1.9 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member centric.
We want to be true health partners to our members, easily guiding the healthcare choices that are right for them. At HCF, our values are the way we do things and create the necessary culture to help us realise our purpose and deliver our 2025 Strategy. Living our values in action we step forward, walk in their shoes, stay human, make it better and get there together.
Culture & Benefits
Purpose-driven passion
At HCF, we’re united by a common purpose: to make healthcare affordable, understandable, high quality and member-focused.
Wellness and work-life balance
We’ll empower you with the necessary skills and tools to support your personal wellbeing journey, ensuring you perform at your best. Our offerings include:
- 50% subsidy on HCF hospital and/or extras cover
- 18 weeks of parental leave for all new parents
- Mental health and wellbeing programs, including workshops, fitness classes, flu vaccinations, skin checks and more
- Discounts on HCF’s products, including life, pet and travel insurance, as well as discounts at Fitness First gyms and on our Eyecare products.
Collaboration and inclusivity
We embrace diversity as our strength and are committed to maintaining an inclusive and collaborative work environment. Our workplace is welcoming and safe for all our employees, irrespective of their unique characteristics including age, ethnicity, cultural or spiritual background, gender identity, disability, education and socio-economic status.
Continuous learning and growth
We believe in lifelong learning. HCF provides opportunities for personal and professional development. From workshops to mentorship programs, we encourage your growth and curiosity.
Next steps
If you require any adjustments to assist you in making your application or during the recruitment or onboarding process, please reach out to Talent Acquisition – vacancy@hcf.com.au to discuss.
We encourage applicants to submit their applications at their earliest convenience, as at HCF, we review applications as they are submitted, and may have filled the role prior to the job closing date.
