Medical Claims Officer

Job no: 503213
Work type: Fixed Term Full Time
Location: Parramatta
About HCF
At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we’ve been putting our members and their health first. As Australia’s largest not-for-profit health fund, we cover over 1.7 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member centric.
Please note this position is a max term position until 1/4/2025
About the Role
Reporting to the Medical Team Leader, this role is responsible for processing high volume Medical Claims. In addition, this role has a strong customer service focus, and it is essential that accurate information and exceptional service in provided responding to enquiries raised by internal customers, members, Medicare Australia and providers. A thorough understanding of the funds policies and procedures are required.
Responsibilities:
Key responsibilities will include:
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
Action reports and perform quality review processes as required
Proactively respond to enquiries from Medicare Australia and providers
About you:
To be successful in this role you will demonstrate the below experience
Previous experience within claims, call centre or administration
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
Ability to set own priorities to ensure individual and team targets are achieved / exceeded
Ability to communicate verbally effectively and courteously and in writing to both internal and external customers
Ability to work autonomously and set own priorities to ensure unit objectives are met
Culture
Working in the health insurance industry, we know how important it is to prioritise the wellbeing of our own people. We want to provide you with the skills and tools you need to support your wellbeing journey, so that you can be at your best.
We’re all about creating a fantastic people experience, guided by our values, so that we can in turn better deliver for our members. We work with our people to create a work experience that is inclusive, supportive, safe and respectful so we can do the best for our members.
Come and join our HCF team!
A career with us – How to Apply
HCF is committed to creating a diverse and inclusive workplace. All suitably qualified applicants will receive equal and fair consideration for employment. Applicants who identify as Aboriginal and/or Torres Strait Islander are actively encouraged to apply.