6 weeks of annual leave Hybrid working model Subsidised private health insurance and discounts on our products and services Have you ever thought of yourself as a bit of a Detective?
Keen eye for detail?
The problem solver of your team?
We have a brand new role in our Benefits Assurance team, as a Payment Integrity Officer (Ancillary).
This role will be responsible for the day-to-day administration of the Teachers Health Ancillary Audit Program, with the purpose of identifying and preventing fraud and benefit leakage through provider and member claiming channels.
The Payment Integrity Officer (Ancillary) bridges the gap between the Provider Relations and Payment Integrity teams from an audit and compliance perspective and plays a back-up role to the Ancillary Provider Relations Officer during times of increased provider administration workload and staff leave.
What we have to offer?
We at Teachers Health have a lot to offer; 6 weeks of annual leave Hybrid working model Subsidised private health insurance and discounts on our products and services Fantastic central location in Surry Hills Employee well-being program An annual corporate wardrobe allowance 18 weeks paid parental leave for eligible employees Additional long service leave Who are we?
Teachers Health was created by teachers for teachers over 65 years ago and is the only health fund exclusively for the education community.
As a not-for-profit health fund, we exist for our members covering the lives of over 400,000 teachers, education staff & their families.
What will you do?
/ How will you help?
Conduct audits on providers and members who demonstrate high volume, non-compliant or unusual claiming behaviours - including collation of historical claims data, request/review of supporting documentation, and communication of rules and breaches.
Investigation and audit of providers and member claims flagged by the Ancillary Claims Team.
Review Provider related tip offs from external sources.
Investigate and assess impact to TH where applicable.
Provide recommendations to Payment Integrity Manager and Provider Relations Officer based on outcomes of various audit activities.
Development and continuous improvement of Standard Operating Procedures for various audit activities.
Participate in external forums and communities of interest to stay updated on about what is happening across the PHI industry in relation to fraud and fraud prevention Provider Relations back-up duties will include maintenance of provider details and provider agreements in HAMBS system, reconciliation of HICAPS/IBA payment files, and responding to provider enquiries and member enquiries relating to provider matters.
What do you need?/What are we looking for?
Knowledge and experience of working in Private Health Insurance Handling claims Experience working with large data sets Keen eye for detail Inquisitive A problem solver How do I apply?
Click APPLY NOW and send in your updated CV and an (optional) cover letter, telling us why you would be a good fit for the role.
Teachers Health values diversity and inclusion and encourages applications from people with diverse backgrounds including First Nations people, people with disability, people from diverse cultural and linguistic backgrounds, and people that identify as LGBTQIA+.
Applicants can request an adjustment at any stage during the recruitment process by getting in touch with ******
