Claims AssessorFull-time | Permanent | Sydney | Doctors Health Fund About the role

We’re looking for an experienced Claims Assessor to join our Doctors Health Fund team.In this role, you’ll be responsible for accurately and efficiently assessing health insurance claims in line with fund rules, policies, procedures and legislation. You’ll also support our members and providers by handling inbound and outbound enquiries and helping resolve claims-related queries.This is a great opportunity for someone with a private health insurance (PHI) background, particularly those with experience assessing hospital claims.

What you'll be doing

- Assessing health insurance claims accurately and within agreed service levels• Assessing hospital claims in accordance with fund rules, policies and legislation• Adjusting claims where required• Handling inbound and outbound calls with members, providers and third parties• Conducting peer reviews to ensure claims and processes are accurate• Keeping up to date with changes to products,



processes and legislation• Participating in coaching and training on new products and processes• Identifying opportunities to improve processes and delivering practical solutions• Supporting other activities relating to the claims and payments process

About you

You’ll be a detail-oriented and customer-focused professional who enjoys working in a fast-paced environment and has a robust understanding of health insurance claims.You’ll bring:

- Experience in private health insurance (PHI) – highly desirable• Previous experience assessing hospital claims• Strong understanding of health insurance claims processes, rules and procedures• Knowledge of claim related systems such as HAMBS, ECLIPSE, etc is desirable• Extensive hands-on customer service experience• Strong data entry skills and a high level of accuracy• Excellent verbal and written communication skills• The ability to manage competing priorities and meet service level requirements• A proactive approach to identifying issues and finding solutions

📌 Claims Assessor (Sydney)
🏢 Avant Mutual
📍 Sydney