Claims Officer

Police Health Limited; Adelaide; Hybrid; AUD 60,000 - 85,000; Full time

Benefits offered by this job

Hybrid working

Monthly day off

Health insurance subsidy

Uniform subsidy

Motor vehicle leasing

Wellbeing initiatives

Job summary

Police Health Ltd in Adelaide is seeking a 0.8 FTE Claims Officer to assess private health insurance claims in line with fund rules and service standards. You will collaborate with members, providers and internal teams to ensure accurate processing and positive outcomes.

Ideal candidates have proven claims experience, strong customer service skills, and familiarity with policies and regulatory requirements. Hybrid work arrangements and supportive benefits are available.

Qualifications

• Proven claims assessing experience.
• Experience in an insurance or claims environment.
• Strong customer service and communication skills.
• High attention to detail and analytical capability.
• Ability to interpret and apply policies, procedures and rules.
• Strong organisational and time management skills.
• Confidence using Microsoft Office and customer systems.
• A collaborative and team-oriented mindset.
• Experience in a service-based or regulated environment.
• Knowledge of private health insurance and associated legislation.

Responsibilities

• Assess health insurance claims accurately and efficiently.
• Review hospital, medical and ancillary claims.
• Manage member and provider claim enquiries.
• Process claim adjustments and recoveries.
• Liaise with Medicare and external providers.
• Support team performance and service targets.

Skills

Claims assessing experience

Insurance environment

Customer service

Attention to detail

Policy interpretation

Organisational skills

MS Office & systems

Team collaboration

Regulated environment

Private health insurance knowledge

Tools

CRM systems

MS Office

Job description

At Police Health, our purpose is to be a trusted partner in providing peace of mind and support for the health and wellbeing of our members. We are a not-for-profit, member focused, national health fund based in SA with our office located in the Adelaide CBD. Founded in 1935, we have a long history of providing high quality and great value private health insurance exclusively, for our Police communities and their families.
Our people are central to everything we do. We foster a positive, flexible and inclusive workplace where collaboration, growth and wellbeing are genuinely supported. We value integrity, courage, curiosity and care, and we’re proud of a culture where people look out for one another and enjoy what they do.

Job Description

The Role

We're looking for a Claims Officer (0.8 FTE) to join our Customer Experience team. In this role, you'll assess a variety of private health insurance claims, ensuring they are processed accurately, efficiently and in line with fund rules, regulatory requirements and service standards. You'll work closely with members, health providers and internal stakeholders to deliver positive outcomes while maintaining the high level of service Police Health is known for.

Key Responsibilities

• Assess health insurance claims accurately and efficiently.
• Review hospital, medical and ancillary claims.
• Manage member and provider claim enquiries.
• Process claim adjustments and recoveries.
• Liaise with Medicare and external providers.
• Support team performance and service targets.

Desired Skills and Experience

About You

You're a detail-oriented and customer-focused insurance professional who enjoys analysing information, applying rules and procedures, and delivering exceptional service. You thrive in a collaborative environment, can manage competing priorities, and take pride in ensuring claims are assessed accurately and fairly.

You'll Bring

• Proven claims assessing experience.
• Experience in an insurance or claims environment.
• Strong customer service and communication skills.
• High attention to detail and analytical capability.
• Ability to interpret and apply policies, procedures and rules.
• Strong organisational and time management skills.
• Confidence using Microsoft Office and customer systems.
• A collaborative and team-oriented mindset.
• Experience in a service-based or regulated environment.
• Knowledge of private health insurance and associated legislation.

Appointment to this role is subject to the successful completion of a National Police Check on commencement and every three years thereafter, as well as confirmation of Australian work rights.

Why Join Us?

You’ll be part of a purpose‑driven, not‑for‑profit organisation where the work you do genuinely makes a difference to members’ health and wellbeing. We offer a supportive and values‑led workplace where collaboration, care and integrity are genuinely lived every day.

The Benefits

Our people value work-life balance and we can not only enable hybrid working once you’re settled into your role, but also offer a monthly day off arrangement.

In addition to competitive remuneration, we offer benefits such as an attractive Police Health Ltd health insurance subsidy, subsided uniform, superannuation salary sacrificing, motor vehicle leasing and varied yearly health & wellbeing initiatives.

Police Health is an equal-opportunity employer and is committed to creating a diverse and inclusive workforce. We encourage all qualified applicants to apply including First Nations Australians, people with disabilities, and people of all genders.