Claims Assessor

Claims Assessor (Ancillary & Medical)Apply locations Sydney CBD time type Full time posted on Posted 2 Days Ago time left to apply End Date: December 15, 2024 (16 days left to apply) job requisition id JR100754
The Ancillary and Medical Claims Assessor will be responsible for processing high volumes of ancillary and medical 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 permanent, full time role is Monday to Friday with hours between 8:30am-5:30pm. This role is based in the Sydney CBD with hybrid working available.
Responsibilities: Assess and process all types of ancillary claims within SLAsReview and pay claims in accordance with Fund Rules and policiesMaintain claims quality by ensuring processing accuracy targets are achieved and error rates are below unit KPI'sAchieve productivity targets as set per unit KPIsProcess rejected, refused, suspended and adjusted claims within standardsRespond to enquiries from providersPerform claims adjustments and initiate follow up/recovery action as requiredAction reports and perform quality review processes as requiredActively assist fellow team members in assessing complicated claimsProvide support to Call Centre on claims related queriesAbout 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 claimsExcellent communication both written and verbalSound understanding of the Fund's products and servicesAbility to work autonomously and set own priorities to ensure unit objectives are metAccuracy of data input skillsBe an effective team playerIntermediate PC skills in Outlook, Excel, Word and fund management systemsSound understanding of medical terminologyAbility to set own priorities to ensure unit objectives are metDesirable: Previous experience processing ancillary or medical claims transactionsPrevious experience in provider fraud detectionExperience in the Private Health Insurance industryAbout RT Health: At RT Health, 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:
50% subsidy on HCF hospital and/or extras cover18 weeks of parental leave for all new parentsMental health and wellbeing programs, including workshops, fitness classes, flu vaccinations, skin checks and moreDiscounts 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.
Next steps: If you require any adjustments to assist you in making your application or during the recruitment or onboarding process, please reach out to Talent Acquisition – ****** to discuss.
We encourage applicants to submit their applications at their earliest convenience, as at HCF, we review applications as they are submitted, and may have filled the role prior to the job closing date.
At HCF, we want our people to feel supported and empowered to be their best self at work. We create a flexible, inclusive, family-friendly culture so our employees are inspired and motivated to achieve the best for themselves and our members.
Our purpose is to bring a human touch to every part of the healthcare system, in big ways and small. Our values inform the way we do things. They help us build the culture we need to realise our purpose. Our values are to:
Step ForwardGet There TogetherMake it BetterStay HumanWalk in Their Shoes.We've invested in our people and teams to ensure they're equipped to reach their career goals. We help team members expand their skill sets and develop personally through various internal and external courses, as well as broaden their on-the-job experience through transfers, secondments or promotions.
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