Claims Assessor
Full-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 strong understanding of health insurance claims.
You'll bring:
Experience in private health insurance (PHI) – highly desirable
Previous experience assessing hospital claims
Solid 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
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📌 Claims Assessor (New South Wales)
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📍 New South Wales