Payment Integrity Officer

1 month ago

Sydney, Australia Teachers Health Full time
  • 6 weeks of annual leave
  • Hybrid working model
  • Fantastic central location in Surry Hills

The Payment Integrity Officer (Ancillary Providers) is responsible for the day-to-day administration of the Teachers Health Ancillary Audit Program, with the purpose of identifying and preventing fraud and benefit leakage through provider claiming channels.

What do we have to offer?

  • 6 weeks of annual leave
  • Hybrid working model
  • Subsidised private health insurance and discounts on our products and services
  • Fantastic central location in Surry Hills 
  • Employee well-being program
  • An annual corporate wardrobe allowance 
  • 18 weeks paid parental leave for eligible employees 
  • Additional long service leave

Who are we?
Teachers Health was created by teachers for teachers over 65 years ago and is the only health fund exclusively for the education community. As a not-for-profit health fund, we exist for our members covering the lives of over 370,000 teachers, education staff & their families.

How will you help?
The Payment Integrity Officer (Ancillary Providers) bridges the gap between the Provider Relations and Payment Integrity teams from an audit and compliance perspective and plays a back-up role to the Ancillary Provider Relations Officer during times of increased provider administration workload and staff leave.

  • Conduct audits on providers who demonstrate high volume, non-compliant or unusual claiming behaviours - including collation of historical claims data, request/review of supporting documentation, and communication of rules and breaches.
  • Identify and monitor providers who are also THF members. Issue warning letters to providers where there has been a breach of Fund Rules to drive behavioral changes and compliance.  
  • Monitoring of claims for Providers who are servicing members while not accredited by their relevant associations. Update HAMBS system to prevent usage of HICAPS/IBA terminals during lapse periods.
  • Investigation and audit of providers and provider claims escalated by Ancillary Claims Team.
  • Review Provider related tip offs from Private Healthcare Australia (PHA), the Department of Health and other industry bodies. Investigate and assess impact to TH where applicable. 
  • Provide recommendations to Payment Integrity Manager and Provider Relations Officer based on outcomes  of various audit activities.
  • Development and continuous improvement of Standard Operating Procedures for various audit activities.
  • Participate in external forums such as the PHA Payment Integrity Community of Interest Group, and the  Members Health Fund Alliance Fraud Committee to learn about what is happening across the PHI industry in relation to fraud and fraud prevention.

What do you need?

  • Demonstrated experience in claims or benefits assessing roles within Private Health Insurance 
  • Relevant tertiary qualifications and/or significant experience within private health insurance or healthcare industry.
  • Amazing attention to detail skills
  • Proficient with MS Office programs, especially Excel.
  • High level communication skills, both written and interpersonal 
  • General understanding of Australian healthcare landscape
  • HAMBS experience or similar (desirable) 

How do I apply?
Click APPLY NOW and send in your updated CV and an (optional) cover letter, telling us why you would be a good fit for the role.

Teachers Health values diversity and inclusion and encourages applications from people with diverse backgrounds including First Nations people, people with disability, people from diverse cultural and linguistic backgrounds, and people that identify as LGBTQIA+. Applicants can request a reasonable adjustment at any stage during the recruitment process by getting in touch with jobs@teachershealth.com.au
 
Please note: All final applicants for this position will be asked to consent to a criminal record check. But even if you have a criminal record, it doesn't automatically exclude you. Each application will be considered on its merits.

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