Claims Assessor

HCF; Sydney; Hybrid; AUD 70,000 - 90,000; Full time

Benefits offered by this job

Flexible working arrangements

Parental leave 18 weeks

Mental health and wellbeing programs

Discounts on HCF products

Job summary

RT Health in Sydney CBD is seeking a Hospital Claims Assessor to process high volumes of hospital claims with a strong customer service focus. You will respond to enquiries from providers and internal customers, ensuring claims are paid in line with Fund Rules and maintaining data accuracy.

This full-time, maximum-term contract runs until October 2028, with hybrid working and a supportive learning culture. Applicants should have experience in private health insurance claims and medical

Qualifications

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

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.

Skills

Claims processing

Customer service

Attention to detail

Communication

Team player

Prioritisation

Medical terminology

Provider enquiries handling

Fraud awareness

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.

The responsibilities of the role include but are not limited to the following:

• 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
• 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.

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.