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 2028. Hours of operation are Monday to Friday between 8:30am-5:30pm. This role is based in the Sydney CBD with hybrid working available.

The responsibilities of the role include but are not limited to the following:

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

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 1889 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.

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:

Versatile working arrangements

50% subsidy on HCF hospital and/or extras cover

Family-friendly certified employer

18 weeks of parental leave for all new 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.

📌 Claims Assessor (Sydney)
🏢 HCF
📍 Sydney