Processing & Resolution Officer - Medical
Exciting opportunity to join a leading not for profit health insurer processing Medical Claims!
Summary about this job
Claims
Company: HCF Australia
Location: Sydney
Work type: Full Time
Salary: n\a
Phone: +61-8-5477-1202
Fax: +61-8-8536-7103
E-mail: n\a
Site: n\a
Detail information about job Processing & Resolution Officer - Medical. Terms and conditions vacancy
- Opportunity to join the largest Not for Profit Health Insurer
- Competitive salary package + discount on private health insurance
- Centrally located at HCF House in Sydney's CBD
About HCF:
HCF is Australia's largest not-for-profit private health insurer. With the adoption of our 2020 Strategy, our vision is to make health care understandable, affordable, high quality and customer centric. We are proud to be home to 1300 employees at our head office location in Sydney, our Australian call centres and our growing network of branches and dental centres across the country. With over 85 years of heritage in Australia, we’re committed to investing in the health and happiness of both our members and our people.
About the role:
The Processing & Resolution Officer role is responsible for processing a high volume of medical claims. In addition, this role has a strong customer service focus and it is essential that accurate information and exceptional service is provided when responding to enquiries raised by Internal Customers, Members, Medicare Australia and Providers. A thorough understanding of the funds policies and procedures are required.
In this role you will be responsible for these Key Result Areas:
- Assess and review all types of medical claims
- Review and pay medical claims in accordance with Fund Rules and Policies
- Maintain claims quality by ensuring processing accuracy targets are achieved and error rates are below unit KPI’s
- Registering Medicover providers and updating provider details, maintain medical provider records and contract details
- Processing of No Gap & Known Gap Medical claims using “PreMac” User interface
- Process rejected, refused, suspended and adjusted claims, using WHICS system
- Maintain medical provider records and contract details
- Perform medical claims adjustments and initiate follow up/recovery action as required
- Deliver exceptional customer service, adhering to Fund and Claims Operations KPI’s
- Support frontline staff in processing and general enquiries
About your experience:
To be successful in this role, you will demonstrate the below experience:
- Strong commitment to providing quality service to both internal and external customers
- Sound knowledge of all HCF products and procedures
- Intermediate PC skills including keyboard and accuracy of data input 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
- Polite and professional telephone manner
- Ability to set own priorities to ensure individual and team targets are achieved / exceeded
- Ability to maintain and enhance unit productivity
- Desire and commitment to work in a team environment
Benefits & culture:
In addition to the salary offered, HCF have a number of employee benefits including:
- Discounts on health insurance and other insurances
- Family and friends day
- Study leave
- Parental leave scheme
- Developmental opportunities
- Comprehensive training and ongoing support
We believe in developing our people to assist in driving continuous improvement within the organisation. At the same time we are dedicated to creating a working culture where staff members can flourish. We work hard to ensure that all our positions are challenging and rewarding, where you can utilise and further develop your skills to truly make a difference.
To submit your application, apply via the link today!