Navy Health Ltd is seeking an experienced
Hospital Claims Auditor
to join our dynamic Claims team. As a Hospital Claims Auditor, you will play a crucial role in ensuring the integrity and accuracy of our hospital claims processes. This position is integral to maintaining Navy Health's reputation for excellence and compliance within the Private Health insurance sector, specifically in claims management.
About us
For 70 years, Navy Health Ltd has provided top-quality, affordable health insurance to serving and ex-serving Australian Defence Force members and their families. With a strong commitment to member satisfaction and operational excellence, we maintain high standards of integrity, compliance and customer service. Our team is passionate about delivering innovative solutions and outstanding service. Navy Health Ltd values its employees and fosters a culture of collaboration, professionalism, development and continuous improvement. We are proud to be part of the Private Health insurance sector, where we make a meaningful difference in the lives of our members.
We are a values driven organisation, our core values are:
Members First, We Care, We are One Team, We act with Integrity and Respect, and We Strive for Better.
What you'll be doing
Reviewing and auditing hospital claims to ensure accuracy, compliance and adherence to policy terms and conditions
Identifying discrepancies and inconsistencies claims through detailed analysis and investigation
Verifying supporting documentation and evidence provided by claimants and healthcare providers.
Liaising with hospitals, healthcare providers and claimants to obtain additional information or clarification where required.
Preparing comprehensive audit reports documenting findings,



recommendations and actions taken.
Ensuring all audits are completed within established timeframes and quality standards.
Contributing to the development and improvement of claims audit procedures and processes.
Maintaining detailed records of all audit activities and maintaining confidentiality of sensitive information.
Supporting the Claims team with ad-hoc projects and special investigations as needed.
What we're looking for
Proven experience in claims auditing, preferably within health insurance.
A Bachelor of Health Information Management, Master of Health Information Management, or an equivalent qualification.
Extensive clinical coding experience, with demonstrated expertise in the ICD-10-AM/ACHI/ACS 13th Edition.
Proven ability to train, mentor, and support clinical coding staff.
Sound knowledge and practical experience using Codefinder.
Demonstrated experience in the extraction, analysis, and submission of health data to external stakeholders and regulatory bodies.
Strong organisational skills, with the ability to plan, prioritise, and manage competing workloads effectively.
Highly developed problem-solving and analytical skills that drive positive outcomes.
Excellent interpersonal, written, and verbal communication skills, with the ability to build and maintain effective stakeholder relationships.




Knowledge of private health sector funding models and casemix funding methodologies. – this is listed as specifically required.
Understanding of the Medicare Benefits Schedule (MBS) and its application within the private healthcare environment. – this is listed as Essential in the PD.
Experience in hospital benefits auditing, health fund reviews, or related healthcare funding activities.
Knowledge of epidemiology, population health, health data analysis, and the interpretation of healthcare trends and outcomes.
What we offer
Navy Health Ltd is committed to supporting the wellbeing and professional development of our employees. We offer a range of benefits including competitive remuneration, access to employee assistance programs, opportunities for career development and training, to enhance your skills and progress your career. Our workplace promotes a cooperative culture where your contributions are valued and recognised. We also offer hybrid/flexible work arrangements, to support work-life balance, and we are committed to creating an inclusive workplace that welcomes diversity.
This is a full-time hybrid position based in Surrey Hills, VIC ****. We are open to part time at a pro rata basis for the right candidate. Our office is close to cafe's, takeaway shops, supermarket, post office, chemist, and coffee! We are close to Union Station/public transport, and there is free all day on street parking nearby.
Please note, only successful candidates will be contacted to move into the first stage of the recruitment process and only candidates with rights to work in Australia should apply.
For a copy of the position description or if you have any questions, email ******
#J-*****-Ljbffr

📌 Hospital Claims Auditor (Melbourne)
🏢 Navy Health
📍 Melbourne