Ancillary Claims Auditor

4 weeks ago

Docklands, Australia Medibank Private Limited Full time

The Opportunity

Working to deliver on the objectives of the Payment Integrity Ancillary strategy, the Ancillary team’s core focus is to prevent improper payments and benefit leakage through detection, monitoring, prevention and investigation of fraud, abuse, waste and error.

The Ancillary Claims Auditor is responsible for the identification, review and assessment of health service providers, members and staff to ensure compliance with Medibank’s recognition criteria, Fund Rules and industry standards.

How will you add value?

The focus of the role will be to continuously identify patterns and trends, provide and share insight with the team and stakeholders to improve operations with a focus on efficiencies, and interpret industry best practices with a focus on high-priority cases, which minimize future loss and mitigate business risk.

This includes:

Undertaking intelligence-led and data-driven identification of irregular claiming activity. Conducting testing of identified rules to determine size and scope of the behavior, the potential return on investment and any other contributing factors or risks. Ability to prioritize activities based on return on investment, quality of care to our members and the member’s experience. Conducting reviews adhering to the principles of natural justice and procedural fairness Undertaking root cause analysis and providing recommendations for remediation of systemic issues Reporting results, making recommendations in a logical, clear and concise manner in a format consistent with Medibank’s guidelines. Maintaining accurate, comprehensive and timely case management records, in accordance with policies and procedures

About you:

You are a natural problem solver with great communication skills and attention to detail You can liaise with people at all levels in an informative, accurate and positive manner You have a keen eye for detail, are analytical and have the ability to detect, interpret and report on patterns and trends. You can identify relevant information from multiple information sources, including regulatory requirements, internal policies and business rules and data sources whilst evaluating risk and return on investment. You are able to prioritize, organize and complete work within established deadlines, and maintain a consistent level of accuracy and professionalism. You can work as a team and autonomously within a structured environment. You are proficient in Microsoft Office products, with accurate word processing and data manipulation skills. You have good working knowledge of excel at an intermediate level, including an understanding of pivot tables and use of formulas and charts Previous experience in a claim audit role is highly desirable

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