Hospital Claims Assessor

About Doctors Health Fund
 
Doctors Health Fund is an award-winning leading provider of private health insurance to Doctors throughout Australia. As a part of the Avant Mutual Group, we look after the needs of over 50,000 health care practitioners, students and their families.
 

About the Role

The principle purpose of the position is to deliver claim assessments to members and providers in accordance with Doctors Health Fund’s rules.

Key Accountabilities:

• Assess Hospital claims accurately in accordance with fund rules, policies, procedures and legislation
• Make adjustments to claims as required
• Undertake coaching and training when required on new products, changes to current products or changes to processes
• Assess claims in a timely manner within service level agreements
• Undertake any other duties related to the claims or payment of claims process
• Accurate peer review of claims and all processes
• Deliver consistent excellent service to members, providers and third party organisations
• Be aware of company strategic goals and how your performance and engagement support these.
• Ensure correct information is given
• Ensure required action or follow up is completed in a timely manner  
• Ensure complaints are handled and reported appropriately
• Ensure each interaction is aligned to our value proposition of expert personal service
• Deliver clear and accurate communication, verbal and written to members, providers and third parties   
• Give and receive feedback in an open , honest and constructive manner     
• Have strong interpersonal skills with all areas of the company
• Be open to others points of view and discuss issues is an open forum
• Be respectful of escalating issues to the appropriate line manager 
• Attend training or coaching on new systems or procedures
• Report any hazards or system issues
• Accurate and appropriate use of system overrides
• Testing changes to the system and new systems
• Locate and use relevant disclosed information 

To be successful you will have:

 
• Strong analytical and decision-making skills with experience in claims assessment and indemnification.
• In-depth understanding of policy wordings, risk assessment, and regulatory requirements.
• Excellent documentation and stakeholder communication skills.
• Ability to train and mentor team members while driving process improvements.
• Proactive and adaptable to change with a focus on continuous learning.
 

Why work at the Doctor’s Health Fund?

Our people and our culture are at the centre of everything we do at Doctors’ Health Fund. By working here, you’ll be part of a dedicated, thriving, inclusive and supportive team environment that champions values of purpose, trust, passion and courage every single day. 
The agile environment in which Doctors’ Health Fund operates allows for everyone to make a difference and be involved in any projects or initiatives, where your contribution and ideas are respected and valued. 
We take your career seriously and provide a safe learning environment and opportunities for professional development and to succeed in your long-term career goals. Together with a comprehensive induction program to kick-start your career at Doctors’ Health Fund, here are some of the great benefits available to you:

• Established flexible working arrangements, promoting a genuine work-life balance
• Sydney CBD location with incredible Darling Harbour views right from your desk 
• Automatic eligibility to become a member of Doctors’ Health Fund, with a 25% discount off your health insurance 
• Free salary continuance insurance and free travel insurance with Avant
• Career, health and wellbeing support through our Employee Assistance Program (EAP), health and wellbeing programs, tertiary education sponsorship and support
• Regular social events and activities throughout the year