WW6702 - Clinical Claims Specialist - (Full-Time) - HBF, Kings Square WA

HBF is Australia’s fifth largest private health insurance provider, and the largest in WA. As a not-for-profit health insurer with no shareholders, our focus is solely on delivering greater benefits and the best experience possible for members.

The Opportunity

We are currently seeking a suitably experienced Health Information Manager or Clinical Coder (Clinical Claims Specialist) to join our Business Integrity team on a permanent, full-time basis.

In this role, you will play an integral part in loss prevention by assisting in the development, implementation and maintenance of loss control strategies to minimise opportunities for loss. You will conduct 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: 
  • Review of hospital and medical claims, to ensure compliance against HBF claiming rules, contracts and industry standards.
  • Participation in the investigation of suspected fraud or inappropriate behaviour committed against HBF as delegated by the Head of Business Integrity
  • 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 case mix analysis for purposes of accurate claims payment
  • Conduct and direct intelligence gathering and analysis, 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
  • Essential: 

    The ideal candidate is able to meet the following selection criteria:

  • Qualification in either Clinical Coding or Health Information Management, with extensive post-graduate or equivalent experience
  • Extensive practical case mix experience
  • A clear understanding of hospital claims processing procedures
  • Highly developed interpersonal and communication skills (written, verbal and listening) with demonstrated high level report writing ability
  • Previous experience or exposure to the private health insurance industry is highly regarded
  • Benefits

    As an employer, HBF offers a range of benefits including a competitive salary, access to flexible working arrangements, wellness days and paid parental leave, generous subsidies on HBF Health and General Insurance, and much more!


    To apply, please click on the "Apply for this job" button and send through a copy of your recent CV along with a covering letter outlining why you want this position.

    Please note, a current National Police Check valid within 3 months will be required as part of the selection process and the right to work in Australia is compulsory.

    Applications close at midnight, Sunday 22nd September 2019.

    Please note HBF has the right to close applications earlier.

    At HBF, we don’t just accept difference we celebrate it, we support it, and we thrive on it for the benefit of our employees, our products, and our community. HBF is proud to be an equal opportunity workplace.

    Recruitment agencies, please note that all HBF vacancies are managed by our internal Recruitment team. Should external assistance be required we will reach out to our panel of providers. Unfortunately, unsolicited agency applications will be returned without review. Your support is very much appreciated.

    Applications Close On: 
    22 September 2019