Job Description
Medical Administration (Healthcare and Medical)
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Full time
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Classifying
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Casemix
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Remarkable people. Remarkable careers.
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At GMHBA, every day is a chance to make a real impact on people's lives. Join our people-focused, not-for-profit health insurer and enjoy a flexible workplace, supportive culture, and a rewarding regional lifestyle. For 90 years, we've put our members, and our people, first. Make your career meaningful with GMHBA.
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Love uncovering patterns, solving complex healthcare billing puzzles, and turning data into meaningful insights?
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We're looking for a passionate and detail-oriented Health Information Manager, Clinical Coder, or Health Data Specialist to join our growing Payments Integrity team at GMHBA.
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In this role, you'll be at the forefront of protecting the integrity of health claims payments-investigating anomalies, identifying opportunities, conducting audits, and ensuring our members receive the right advantages while maintaining compliance across the healthcare landscape.
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If you're someone who enjoys combining healthcare expertise, analytics, auditing, and problem-solving, this could be the perfect next step in your career
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Why This Role Stands Out:
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Investigate complex hospital and medical claims
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Detect trends, anomalies, and payment leakage opportunities
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Use your clinical coding and classification expertise to influence business decisions
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Collaborate with healthcare providers and industry stakeholders
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Drive improvements that enhance operational performance and member outcomes
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Be part of a team that values curiosity, innovation, and continuous improvement
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What You'll Be Doing
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Conduct audits of hospital and medical claims to identify inaccuracies and recovery opportunities.
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Analyse claims and clinical records to ensure correct benefit application.
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Investigate unusual billing patterns and provider outliers.
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Partner with healthcare providers to resolve complex claim issues.
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Generate insights and recommendations through data analysis and reporting.
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Support business initiatives that strengthen claims integrity and reduce risk.
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Provide expert guidance on health classifications, coding standards, and funding models.
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What We're Looking For
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Clinical Coder
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Health Data Analyst
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Health Funding or Casemix Specialist with experience working within the Australian healthcare sector.
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You'll Bring:
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Strong knowledge of private health funding, hospital billing, casemix, and classification systems.
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Experience interpreting claims data, clinical documentation, and identifying discrepancies.
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Excellent analytical, communication, and stakeholder engagement skills.
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Experience using reporting tools and working with large datasets.
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A proactive mindset with a passion for continuous improvement and problem-solving.
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Bonus Points If You Have:
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Experience with 3M Health Information Systems, Reports Manager, or Rule Authoring Applications.
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Strong data analytics capability and experience working with SQL to extract, interrogate, and analyse complex health claims data.
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Experience identifying trends and developing data-driven audit strategies.
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Why Join GMHBA?
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At GMHBA, your work directly contributes to ensuring fairness, accuracy, and value across the healthcare system. You'll join a supportive team where your expertise is valued, your ideas are welcomed, and your impact is visible.
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Whether you're uncovering hidden insights, improving processes, or influencing strategic decisions, you'll play a vital role in helping us deliver better outcomes for our members and providers.
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If you have any questions about this position or the recruitment process
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📌 Health Information Manager (Victoria)
🏢 GMHBA
📍 Victoria