Seeking skilled claims manager to lead a dynamic team, and ensure timely, fair resolution. Join us to drive efficiency, customer satisfaction, and compliance in a growing insurance company.
About the opportunity? We are seeking individuals who will be responsible for the management of hospital, medical, and ancillary claims, empowering and up-skilling our people, and effectively engaging and delivering with internal and external partners. This role will also be responsible for the management of the claim's integrity function of Queensland Country Health Fund.
This key role contributes to the HBF Promise by providing leading the Claims and Claims Integrity team who undertake claim, membership, product, system & process related enquiries, whilst actively promoting the delivery of excellent Member service.
Key Responsibilities: Leading a team to deliver exceptional levels of service for our members. Achieving productivity and efficiency through effective team leadership. Coaching and mentoring a team to create high performing, culturally aligned and motivated employees. Ownership and understanding of an end-to-end processing domain and member journey. Contribute towards problem solving and making informed decisions around courses of action required to keep cross-functional teams moving forwards and to deliver desired results. Review and enhance the claims processing functions to achieve operational efficiencies while maintaining an appropriate level of service to Members. Manage member obligations and risks through adherence to Fund Rules, Business Rules, and control environment. Oversee the claims management functions of Queensland Country Health Fund/Territory Health Fund to effectively manage the compliance and payment integrity of claims paid, including provider and Member claiming fraud, abuse, waste, and error. Manage ex-gratia and high-cost drug requests and prepare proposals for consideration by senior management (when requests fall outside the parameters of the Claims Manager approval delegation). Manage the pre-existing condition assessment process and liaise with the Fund appointed Medical Advisor on related issues. Ensure that all Member transactions including ancillary, medical and hospital claims are appropriately verified and processed. Review and propose the acceptance or rejection of new hospital and broader health cover agreement received through the AHSA. Provide support, guidance, ongoing feedback and recognition to team members as part of HBF's people management practices. Support HBF's Vision and its commitment to total quality service and continuous improvement by contributing ideas and suggestions for improvements, and by participating in projects and/or workshops etc. Key Requirements: Strong Leadership and team management skills. Outstanding problem-solving and decision-making abilities. Exceptional communication and customer service skills. Ability to manage multiple priorities. Benefits: Fully subsidised Gold Hospital Elevate Insurance Cover* 3 additional wellbeing days off a year (on top of our standard 20 days annual and 10 days personal leave). 2 volunteering days per year. 14 weeks paid parental leave. Generous salary packaging options. Career development opportunities. Awards and recognition. Access to corporate discounts across a range of gyms, retail, restaurants, and hotels. (Note: leave entitlements are pro rata. * After probation period) Sound good? Let's get into it - It's simple and quick! Just click on the "Apply Now" button to complete your application.
About HBFAs one of WA's longest established private health providers, (we've been around for 80 years!), we continue to innovate and challenge the status quo; adopting a strategy that focuses on business growth and sustainability, diversification, national expansion and significant enhancements to how we service our members through technology and relevant related businesses.
As a not-for-profit fund with no shareholders, we are dedicated to doing the right thing for our members. That's why our iconic brand's reputation is built on personalised service, community support and a motivation to deliver for our members in the moments that matter.
When you work for HBF, you work for a company with a clear vision and a team of people that are passionate about providing the best service, experience, and products for our members across Australia.
Our ValuesAt HBF, we live our values every day. They shape our behaviours and how we relate to each other, our members, and our community:
Members are our reason - Members are the reason we exist and are at the heart of everything we do.We do the right thing - We are open and honest in everything we do. We do what is right, not what is easy and explain why we are doing it.We are brave - We are brave in the way we will tackle the future. We're driven by curiosity, and constantly look for better ways to work smarter, faster, and more innovatively.We work as one - We act as one HBF because we're better together. We work not as individuals but as a team to achieve more.
Our recruitment and selection process include a variety of assessment methods that may encompass psychometric assessments, reference checks and verification of working rights in Australia. Preferred candidates will be required to return a satisfactory National Police Clearance prior to an offer of employment being extended. At HBF, we don't just accept difference - we celebrate it, we support it, and we thrive on it for the benefit of our employees, our products, and our community. HBF is a place of belonging. We are proud of who we are, and we encourage applications from diverse groups such as Indigenous and Torres Strait Islander people, physical ability, age, sexual orientation, gender identity or expression and family background, including caring responsibilities. All HBF vacancies are managed by our internal Talent Acquisition team. Unsolicited agency applications will be returned without review.
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