Hospital Claims Specialist

Sydney, NSW
Permanent
Full-time

9 days ago

About Doctors Health Fund:Doctors’ Health Fund is a leading provider of private health insurance exclusively for the medical community across Australia. As part of the Avant Mutual Group, we proudly support over 70,000 healthcare professionals, students, and their families. Our commitment to members is at the heart of everything we do - driven by our values, mission, and people-first culture.About the Role:We are seeking a Hospital Claims Specialist to join our Claims & Business Operations team. In this role, you will be responsible for accurately assessing and processing hospital claims in line with Doctors Health Fund rules, policies and procedures while delivering exceptional service to our members, providers, and third-party organisations. This role involves some inbound and outbound phone contact, providing clear and timely communication, and identifying opportunities to improve processes. You will play a key part in ensuring service expectations are consistently met in a high-volume environment.Key Accountabilities:

Accurately assess claims in accordance with Doctors Health Fund Rules, policies, procedures, and legislative requirements, within service level agreements.
Handle inbound and outbound calls, ensuring timely, accurate and professional communication with members, providers, and third parties.
Maintain comprehensive knowledge of systems and products.
Deliver clear, professional, and respectful written and verbal communication with internal and external stakeholders.
Work towards individual and team KPIs, take ownership of outcomes, and share knowledge with peers to drive success.
Ensure adherence to privacy, APRA, PHI Act, and WH&S requirements.
Support staff development by creating training materials, delivering training sessions and maintaining accurate training records.

To be Successful you will have:

3+ years experience in same/similar Senior Hospital Claims Assessor role.
HSC or equivalent preferred.
Customer service background.
Insurance or health industry experience.
Data entry and administrative experience.
Strong decision-making and problem-solving ability.
Excellent written and verbal communication.
High attention to detail with strong organisational skills.
Proficiency in computer systems and ability to adapt to new technology.
The ability to work collaboratively and contribute as a strong team player.
Results-driven mindset.

Avant Mutual Group

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