Benefit Integrity Officer

Benefit Integrity Officer Join the Benefit Integrity team at HCF Australia based in the heart of Sydney CBD. The objective of the team is to ensure HCF acts with integrity in fulfilling our legal and ethical obligations to members and providers. The team implements effective payment approaches that control unnecessary and inappropriate costs, helping keep private health insurance affordable for Australian members. Contract until the end of June 2027. Role Overview The Benefit Integrity Officer supports the Policy and Audit Manager and is responsible for: Supporting the identification, mitigation, elimination and management of benefits inaccuracies and leakage Contributing to audit and recovery activities undertaken by the team Corresponding with providers and members regarding claims and audits Maintaining accurate reports and records Key Focus Areas Assist broader identification, mitigation, and elimination of benefits inaccuracies and leakage Identify system improvements to enhance audit and recovery efficiency Support recovery of monies from providers on behalf of HCF where possible Record progress on departmental activities and recovery processes Report monthly on savings and recoveries Liaise with providers and members on all matters concerning audited/recoverable claims Manage correspondence and enquiries related to possible recoveries and related claims Ensure records and files are accurate, up to date, and accessible Support sensitive claims reviews and investigations Comply with HCF’s Risk Management Framework, Strategy, Manual, and risk/compliance procedures Perform other duties as required to support the effective operation of the Benefit Integrity unit and Member Health team Essential Skills, Experience, and Qualifications Proven capacity in a similar role, with minimum 1‑year experience liaising with providers and members Minimum of 1‑year clinical experience Innate curiosity, ability and desire to learn Strong English written and verbal communication skills Fully conversant in MS Word, with basic MS Excel skills Excellent attention to detail Ability to work unsupervised in a team environment Methodical, organised, and committed to continuous improvement Tact, diplomacy, and ability to maintain confidentiality Excellent customer service skills (internal and external) Desirable Tertiary qualification in a relevant area Minimum of 1‑year private health insurance experience About HCF At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we’ve been putting our members and their health first. As Australia’s largest not‑for‑profit health fund, we cover 2 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member‑centric. We want to be true health partners to our members, easily guiding the healthcare choices that are right for them. Our values are the way we do things and create the necessary culture to help us realise our purpose and deliver our strategy. Culture & Benefits 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 eye‑care products 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 the role may be filled prior to the job closing date. #J-18808-Ljbffr