Claims Assessor

The Hospitals Contribution Fund Of Australia Limited; Sydney; Hybrid; AUD 65,000 - 90,000; Full time

Job summary

The Hospitals Contribution Fund Of Australia Limited is seeking a Hospital Claims Assessor in Sydney CBD with hybrid work options. You will process high volumes of hospital claims, respond to internal customers, members, Medicare Australia and providers, and ensure accuracy in line with Fund policies.

This is a full-time, maximum-term contract to October 2028, with hours 8:30am–5:30pm, Monday to Friday. The role emphasizes attention to detail, strong customer service, and experience in a contact

Qualifications

• Previous proven experience of processing hospital claims.
• Excellent communication, written and verbal.
• Good data input accuracy and attention to detail.
• Strong team player and ability to prioritise tasks.
• Intermediate PC skills in Outlook, Excel and Word.
• Sound understanding of medical terminology.

Responsibilities

• Assess and process all types of hospital claims within SLAs.
• Review and pay claims in accordance with Fund Rules and policies.
• Maintain claims quality with accuracy targets and low error rates.
• Achieve productivity targets per unit KPIs.
• Process rejected or adjusted claims within standards.
• Respond to enquiries from providers.
• Perform claims adjustments and follow-up/recovery actions.
• Support quality reviews and assist teammates on complex claims.
• Provide support to Contact Centre on claims queries.

Skills

Claims processing experience

Excellent communication

Data accuracy

Team player

Outlook/Excel/Word proficiency

Medical terminology

Prioritization

Tools

Outlook

Excel/Word

Fund management systems

Job description

Take the next step in your career and join the Claims team.

About the Role

As the Hospital Claims Assessor you will be responsible for processing high volumes of hospital claims. This role has a strong customer service focus, and it is essential that accurate information and exceptional service is provided in responding to enquiries raised by internal customers, members, Medicare Australia and providers. A thorough understanding of the funds policies and procedures are required. This is a full time, maximum term contract until October 2028. Hours of operation are Monday to Friday between 8:30am-5:30pm. This role is based in the Sydney CBD with hybrid working available.

Responsibilities

• Assess and process all types of hospital claims within SLAs
• Review and pay 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
• Achieve productivity targets as set per unit KPIs
• Process rejected, refused, suspended and adjusted claims within standards
• Respond to enquiries from providers
• Perform claims adjustments and initiate follow up/recovery action as required
• Action reports and perform quality review processes as required
• Actively assists fellow team members in assessing complicated claims
• Provide support to Contact Centre on claims related queries

About You

You are solutions focused with strong attention to detail and have exceptional customer service skills.

You will have experience in a contact centre, ideally within private health insurance claims.

You will have:

• Previous proven experience of processing claims
• Excellent communication both written and verbal
• Sound understanding of the Fund’s products and services
• ensure unit objectives are met
• Accuracy of data input skills
• Be an effective team player
• Intermediate PC skills in Outlook, Excel, Word and fund management systems
• Sound understanding of medical terminology
• Ability to set own priorities to ensure unit objectives are met

Desirable

• Previous experience processing hospital, ancillary or medical claims transactions
• Previous experience in provider fraud detection
• Experience in the Private Health Insurance industry

About RT Health

At RT Heath, we’re all about community. It’s the reason we were founded back in 1889 and it’s why we’re still here today supporting more than 48,000 hardworking Aussies across the rail, transport and energy industries. Australia’s first registered health fund and proudly not for profit, we’ve spent 130+ years supporting our members with great value health cover and a level of care that we’re known for. We’re now a proud division of HCF, Australia’s largest not-for-profit health fund but we remain focused on our commitment to support hardworking men, women and families on their health journeys. Our members come first. Always.

Culture & Benefits

Purpose-driven passion

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:

• Flexible working arrangements
• 50% subsidy on HCF hospital and/or extras cover
• Family-friendly certified employer
• 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 and provide opportunities for personal and professional development. From workshops to mentorship programs, we encourage your growth and curiosity.