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Claims Assessor - Hospital Claims

Work type: Full time
Location: Sydney CBD

Exciting opportunity for a professional and energetic Claims Assessor to join our Hospital Claims Team.
Monday to Friday - Set Shifts - 37.5 hour week
Salary - $61, 149 incl 9.5% Superannuation
Permanent Position
About the Role
As Claims Assessor you are responsible for assessing member claims, understanding of Fund policies and procedures and providing accurate information to internal and external stakeholders and providers.  To be successful in this role you must display a high degree of accuracy and detailed understanding of HPPA contracts and terms is essential as is the payment of claims within contract terms.
Reporting to the Hospital Claims Team Leader you be responsible for Claims Assessment, Member Retention and Administration. These key result areas include:
Assess and process all types of hospital claims within SLA’s.
Assess and review claims in accordance with Fund Rules eliminating overpayments/unnecessary rejections.
Maintain claims quality by ensuring processing accuracy targets are achieved.
Maintain error rates below unit KPI’s.
Handle any inquiries and resolve problems to within customer service standards.
Achieve agreed claim volumes through number of claims/lines processed.
Process suspense claims and turnaround within standards.
Respond to enquiries from providers.
Liaise with HMUR on clinical issues and/or unusual billing practices identified in assessing.
Resolve member enquiries to ensure customer service standards are achieved.
Deliver an exceptional customer experience whilst adhering to Fund and SLA’s.
Ensure all member correspondence is within SLA’s.
Ensure members comply with membership claiming requirements.
Achieve productivity targets as set per unit KPI’s.
Actively assist fellow team members in assessing complicated claims.
Provide support to Provider Services team, Call Centre and branch staff.
Identify and make recommendations for improved efficiencies to existing processes and procedures within the unit.
Regularly shares assessing information with team members.
 About your experience
To be successful in this role you will demonstrate the below experience
A background in claims and Insurance (ideally health) would be ideal.
Strong attention to detail.
Excellent communication both written and verbal.
Ability to adapt positively to changing work practices and needs.
Ability to work autonomously and set own priorities to ensure unit objectives are met.
Be an effective team player.
About HCF
We are Australia’s leading not for profit health fund employing over 1000 people across Australia. At HCF, we never lose sight of the role we play in other’s health and wellbeing, each of us is dedicated to our vision for our members; to make healthcare understandable, affordable high quality and customer centric.
Next Steps
To apply, please click the link below to be directed to our careers site.

Advertised: Monday, 26 Feb 2018
Applications Close: Friday, 23 Mar 2018

More information on this Job

ID: 11876243 - Save Job
Category: Jobs : Health Care Jobs
Employer Info:
Claims Assessor - Hospital Claims HCF


The success of HCF depends on attracting and retaining staff members dedicated to our core values. We believe in developing our people to assist in driving continuous improvement, and creating a culture where experienced, professional and caring staff members flourish. We work hard to ensure that all our positions are challenging and rewarding, where you can utilise and further develop your skills to truly make a difference.

HCF offers excellent working conditions and benefits:
Our dental centres are modern and well-equipped
We practice modern conservative dentistry
We have a large network of HCF Branches across NSW/ACT offering excellent working conditions.
Our Head Office is located in Sydneys CBD, and we also have staff located in Melbournes Box Hill.
You have access to our study assistance program to undertake education related to your field of expertise.
We offer our staff members discounted healthcare
You have the opportunity to be part of a not-for-profit organisation built on strong values, with a clear vision for your future.



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