Senior Clinical Claims Analyst
Terrific opportunity for a RN seeking to move into a corporate role! Use your clinical knowledge and admin skills to analyse & assess complex claims.
Summary about this job
Nursing - Management
Company: Australian Unity
Location: Melbourne
Work type: Full Time
Salary: Salary package + performance bonus + benefits
Phone: +61-3-9689-4702
Fax: +61-3-8977-9118
E-mail: n\a
Site: n\a
Detail information about job Senior Clinical Claims Analyst. Terms and conditions vacancy
- Values based culture - Bold, Warm & Honest
- No shift work!
- Join us and thrive!
• Located in Albert Road, South Melbourne
• Permanent full time opportunity
• Join us and thrive!
Australian Unity is a national health, wealth and living mutual company providing products and services designed to help people thrive. More than one million Australians have created a brighter future with us. We are a mutual organisation with 280,000 members, more than 7000 employees and generating more than $2 billion in revenues per annum.
Your Role
We now have an exciting opportunity available within the Claims Integrity Team for an experienced Senior Clinical Claims Analyst. Reporting to the Executive Manager - Claims Integrity and Clinical, you will be required to ensure that complex Private Health Insurance (PHI) hospital claims that require further clinical determination are assessed against agreed business principles. This will be performed according to measures including the consistent application of clinically robust decision making, quality of documentation and performance within specified time constraints.
You will be providing consultative support for key stakeholders across the business involved in claims analysis, provider relations, claims integrity and quality assurance with the aim to minimise inappropriate claims payments for Australian Unity Health Insurance. This includes performing the role with a high regard for members and their needs whilst being mindful of business objectives.
To be successful in securing this role you will have:
• A relevant Degree/Diploma/Certificate with Post Graduate qualifications being highly regarded
• Current AHPRA Registered Nurse (Division 1) General Registration
• Recent acute care clinical experience or equivalent
• Strong attention to detail
• Demonstrated problem solving and analytical skills
Desirable but not essential:
• An understanding of MBS, DRGs. Government legislation and regulations, particularly the Private Health Insurance Act 2007
• Experience working in the PHI Industry
• An understanding of process improvement activities
Your work at Australian Unity will be focused on helping others to thrive, and so we seek to create a work environment that supports you to thrive in your career. We operate with commercial principles and with a strong social purpose to create community value. The culture at Australian Unity is one that truly operates from its values of Bold, Warm and Honest and we are keen to connect as a priority with those who align with this. We also offer a broad range of benefits and incentives.
Join us and thrive!