Take the next step in your career and join the Claims team.
About the Role
As the Hospital Claims Assessor you will be responsible for processing high volumes of hospital claims.
This role has a strong customer service focus, and it is essential that accurate information and exceptional service is provided in responding to enquiries raised by internal customers, members, Medicare Australia and providers.
A thorough understanding of the funds policies and procedures are required.
This is a full time, maximum term contract until October ****.
Hours of operation are Monday to Friday between 8:30am-5:30pm.
This role is based in the Sydney CBD with hybrid working available.
Responsibilities
Assess and process all types of hospital claims within SLAs
Review and pay claims in accordance with Fund Rules and policies
Maintain claims quality by ensuring processing accuracy targets are achieved and error rates are below unit KPI's
Achieve productivity targets as set per unit KPIs
Process rejected, refused, suspended and adjusted claims within standards
Respond to enquiries from providers
Perform claims adjustments and initiate follow up/recovery action as required
Action reports and perform quality review processes as required
Actively assists fellow team members in assessing complicated claims
Provide support to Contact Centre on claims related queries
About You
You are solutions focused with strong attention to detail and have exceptional customer service skills.
You will have experience in a contact centre, ideally within private health insurance claims.
You will have:




Previous proven experience of processing claims
Excellent communication both written and verbal
Sound understanding of the Fund's products and services
ensure unit objectives are met
Accuracy of data input skills
Be an effective team player
Intermediate PC skills in Outlook, Excel, Word and fund management systems
Sound understanding of medical terminology
Ability to set own priorities to ensure unit objectives are met
Desirable
Previous experience processing hospital, ancillary or medical claims transactions
Previous experience in provider fraud detection
Experience in the Private Health Insurance industry
About RT Health
At RT Heath, we're all about community.
It's the reason we were founded back in **** and it's why we're still here today supporting more than 48,000 hardworking Aussies across the rail, transport and energy industries.
Australia's first registered health fund and proudly not for profit, we've spent 130+ years supporting our members with great value health cover and a level of care that we're known for.
We're now a proud division of HCF,



Australia's largest not-for-profit health fund but we remain focused on our commitment to support hardworking men, women and families on their health journeys.
Our members come first.
Always.
Culture & Benefits
Purpose-driven passion
We're united by a common purpose: to make healthcare affordable, understandable, high quality and member-focused.
Wellness and work-life balance
We'll empower you with the necessary skills and tools to support your personal wellbeing journey, ensuring you perform at your best.
Our offerings include:
Flexible working arrangements
50% subsidy on HCF hospital and/or extras cover
Family-friendly certified employer
18 weeks of parental leave for all current parents
Mental health and wellbeing programs, including workshops, fitness classes, flu vaccinations, skin checks and more
Discounts on HCF's products, including life, pet and travel Insurance, as well as discounts at Fitness First gyms and on our eyecare products.
Collaboration and inclusivity
We embrace diversity as our strength and are committed to maintaining an inclusive and collaborative work environment.
Our workplace is welcoming and safe for all our employees, irrespective of their unique characteristics including age, ethnicity, cultural or spiritual background, gender identity, disability, education and socio-economic status.
Continuous learning and growth
We believe in lifelong learning and provide opportunities for personal and professional development.
From workshops to mentorship programs, we encourage your growth and curiosity.
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📌 Claims Assessor (Sydney)
🏢 The Hospitals Contribution Fund Of Australia
📍 Sydney