Take the next step in your career and join the Claims team.About the RoleAs 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.ResponsibilitiesAssess and process all types of hospital claims within SLAsReview and pay claims in accordance with Fund Rules and policiesMaintain claims quality by ensuring processing accuracy targets are achieved and error rates are below unit KPI'sAchieve productivity targets as set per unit KPIsProcess rejected, refused, suspended and adjusted claims within standardsRespond to enquiries from providersPerform claims adjustments and initiate follow up/recovery action as requiredAction reports and perform quality review processes as requiredActively assists fellow team members in assessing complicated claimsProvide support to Contact Centre on claims related queriesAbout YouYou 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 claimsExcellent communication both written and verbalSound understanding of the Fund's products and servicesensure unit objectives are metAccuracy of data input skillsBe an effective team playerIntermediate PC skills in Outlook, Excel, Word and fund management systemsSound understanding of medical terminologyAbility to set own priorities to ensure unit objectives are metDesirablePrevious experience processing hospital,



ancillary or medical claims transactionsPrevious experience in provider fraud detectionExperience in the Private Health Insurance industryAbout RT HealthAt 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 & BenefitsPurpose-driven passionWe're united by a common purpose: to make healthcare affordable, understandable, high quality and member-focused.Wellness and work-life balanceWe'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 arrangements50% subsidy on HCF hospital and/or extras coverFamily-friendly certified employer18 weeks of parental leave for all recent parentsMental health and wellbeing programs, including workshops, fitness classes, flu vaccinations, skin checks and moreDiscounts 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 inclusivityWe 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 growthWe 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