WW6328 - Clinical Claims Specialist - (Full-time) - HBF - Perth, WA

We're making healthy happen.

HBF is a leading WA employer that offers a range of benefits including a competitive salary, flexible working arrangements, Health Insurance subsidy, General Insurance discounts, and much more. We also offer an award-winning wellbeing program.

This position contributes to the HBF Promise by conducting audits and desktop reviews of clinical claims to determine the appropriateness of those claims and, where necessary and in accordance with HBF policies, seek recovery of benefits incorrectly paid.

Responsibilities / Duties: 
  • Development of offsite and on-site clinical review & audit processes to ensure timely and planned review of HBF clinical claims and providers
  • Provide guidance on clinical coding and DRG casemix analysis for purposes of accurate claims payment
  • Participation in the investigation of suspected fraud or inappropriate behaviour committed against HBF as delegated by the Head of Group Loss
  • Assist in developing, implementing and maintaining loss control measures to minimize opportunities for loss through inappropriate payments
  • Conduct and direct intelligence gathering and analyses, utilising traditional and electronic means
  • Report on the outcomes of reviews & investigations with respect to identification of any improper, unprofessional and inappropriate behaviour of providers and/or members with justifiable recommendations

  • Degree in either Health Information Management/Nursing or an experienced Clinical Coder with extensive post graduate or equivalent experience
  • Extensive practical Casemix experience
  • A clear understanding of hospital claims processing procedures
  • Ability to read, decipher and properly categorise clinical treatment records
  • Highly developed verbal and written communication skills, with demonstrated high level report writing ability
  • Demonstrated high level of interpersonal skills, including the ability to build strong relationships, influence others at all levels and deal compassionately and fairly with people in stressful situations
  • Analytical skills including use of Microsoft excel
  • Ability to share knowledge of clinical matters, in simplified terms to those without a clinical background


Email enquiries to:

Applications Close On: 
25 June 2018