Clinical Claims Specialist

HBF is Australia’s fifth largest private health insurance provider, and the largest in WA. As a not-for-profit health insurer with no shareholders, our focus is solely on delivering greater benefits and the best experience possible for members.

While WA remains home to its core business and operations, HBF is undertaking a significant strategic transformation program that involves national growth, business expansion and significant enhancements to technology capability.

Our reputation is built on strong customer service, community responsiveness and a determination to deliver for our members in the moments that matter.

The Opportunity
HBF is currently seeking an experienced Health Information Manager or Clinical Coder to join our Business Integrity team as a Clinical Claims Specialist. This role will be offered to the successful candidate as a permanent, full-time opportunity.

In this role, you will play an integral part in loss prevention by assisting in the development, implementation and maintenance of loss control strategies to minimise opportunities for loss. You will conduct audits and desktop reviews of clinical claims to determine the appropriateness of those claims and, where necessary, and in accordance with HBF policies, seek recovery of benefits incorrectly paid.

Key Responsibilities

• Review of hospital and medical claims, to ensure compliance against HBF claiming rules, contracts and industry standards.
• Participation in the investigation of suspected fraud or inappropriate behaviour committed against HBF as delegated by the Head of Business Integrity
• Development of offsite and on-site clinical review & audit processes to ensure timely and planned review of HBF clinical claims and providers
• Provide guidance on clinical coding and DRG case mix analysis for purposes of accurate claims payment
• Conduct and direct intelligence gathering and analysis, utilising traditional and electronic means
• Report on the outcomes of reviews & investigations with respect to identification of any improper, unprofessional and inappropriate behaviour of providers and/or members with justifiable recommendations

About You
The ideal candidate is able to meet the following selection criteria:

• Qualification in either Clinical Coding or Health Information Management, with extensive post-graduate or equivalent experience
• Extensive practical case mix experience
• A clear understanding of hospital claims processing procedures
• Highly developed interpersonal and communication skills (written, verbal and listening) with demonstrated high level report writing ability
• Previous experience or exposure to the private health insurance industry is highly regarded
• Lateral thinker with strong problem-solving skills

Our Values
Members are our reason
We do the right thing
We are brave
We work as one

Benefits
As an employer, HBF offers a range of benefits including a competitive salary, access to flexible working arrangements, wellness days and paid parental leave, generous subsidies on HBF Health and General Insurance, and much more!

How to Apply
To apply, please click the provided link to be directed to our HBF Careers page to submit your application including a copy of your resume and covering letter outlining why you are interested in this role.

Applications close midnight, Sunday 28th June 2020. Please note HBF has the right to close applications earlier.

Please note that our compliance process includes but may not be limited to completing a National Police Clearance, reference checks 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 proud to be an equal opportunity workplace.

Recruitment agencies, please note that all HBF vacancies are managed by our internal Recruitment team. Should external assistance be required, we will reach out to our panel of providers. Unfortunately, unsolicited agency applications are not accepted and will be returned without review. Your support is very much appreciated.