Claims Officer

About the Role

As a Hospital Claims Assessor you are responsible for assessing member claims associated with hospital admission. This role requires understanding of Fund policies and procedures and providing accurate information to internal and external stakeholders and providers.

To be successful in this role you must display a high degree of accuracy and detailed understanding of HPPA contracts and terms is essential as is the payment of claims within contract to the Hospital Claims Team Leader you be responsible for Claims Assessment Member Retention and Administration.

This is a full time permanent role based at Parramatta. Hours are 8:30am to 5pm from Monday to Friday with hybrid working available.

These key result areas include:
Assess and process all types of hospital claims within SLAs
Assess and review claims in accordance with Fund Rules eliminating overpayments/unnecessary rejections
Maintain claims quality by ensuring processing accuracy targets are achieved
Handle any inquiries and resolve problems for members and providers
Process suspense claims and turnaround within standards.
Deliver an exceptional customer experience whilst adhering to Fund and SLAs
Provide support to Provider Services team Contact Centre and Branch staff

About You

You will have strong customer service skills and previous experience within insurance claims call centre or administration roles.
To be successful you will have:
Strong attention to detail
Ability to adapt positively to changing work practices and needs.
Intermediate PC skills with accurate data entry skills
Ability to adapt positively to changing work practices and needs
Proficient understanding of WHICS ECLIPSE PreMac especially in relation to reassessments and claims processing
Ability to communicate verbally effectively and courteously and in writing to both internal and external customers.

About HCF

At HCF our purpose is to bring our human touch to healthcare. Since 1932 weve been putting our members and their health first. As Australias 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. At HCF our values are the way we do things and create the necessary culture to help us realise our purpose and deliver our Strategy. Living our values in action we step forward walk in their shoes stay human make it better and get there together.

Culture & Benefits

Purpose-driven passion
Were united by a common purpose: to make healthcare affordable understandable high quality and member-focused.

Wellness and work-life balance
Well 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 HCFs 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. HCF provides 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.