Claims Integrity Analyst

About Health PartnersWe’re on South Australia’s side and have been for 85 years now. Our mission has been to bring about a better state of health by making it easier for South Australians to access the health care and support they need, while finding new ways to give back to the communities we call home. No matter where or how we grow, our focus will always be helping locals live in a better state of health.We’re proud to be a not-for-profit – and prouder still to be guided by doing what’s right for our members, our people, and the broader community too. As South Australia’s largest open Health Insurer providing cover to over 90,000 people, we are on our members side for the moments that matter.We are now seeking a Claims Integrity Analyst to join our team to provide support across a range of Provider Integrity business objectives and champion claims compliance!About the roleThe Claims Integrity Analyst plays a critical role in ensuring claims payments comply with legislation, fund and reasonability rules by developing and maintaining effective system controls and measures. With key focuses in system rules and maintenance, analysis and reporting and provider integrity support, this role provides a fantastic opportunity for a data analyst to contribute to various operational activities and business objectives within our Provider Integrity space.Key responsibilities:Updating benefit conditions within the relevant systems as required to ensure benefits are assessed correctly for new and existing products.Providing advice to the business on any proposed changes to health fund products, particularly the required benefit conditions to support these changes.Developing and maintaining claims compliance and reasonability rules in the relevant systems and search engines.Developing and maintaining various data statistic reports and performing analysis to monitor risk and to inform on strategic and tactical activities.Investigating and resolving issues with claims transactions.Assisting with the testing of system changes related to Provider Integrity.Participating in business plan activities and reviewing and updating procedure documentation as required.About youTo be successful in the role you will have:Bachelor of Data Analytics or relevant degree and/or relevant experience.Private health insurance claim assessment and validation experience.System based data analysis and reporting experience.Knowledge of the Privacy Act and of the Medicare Benefit Schedule.HCP data and ICD coding experience.Proficiency in data query tools including SQL, Power Pivot, Power BI.What’s on offer?Generous employee benefits including:Paid parental leaveAllowance on your private health insurance premiumDiscounted sunglassesFlexible and hybrid workingAccess to internal and external learningVolunteer days to work with our partner charitiesAccess to our Employee Assistance Program for you and your familyAccess to discounted gym memberships and wellbeing programs You must be an Australian citizen or permanent resident at the time of submitting your application, be able to provide two recent referees and hold a current satisfactory National Police Clearance (within 12 months) or be willing to obtain prior to commencement. Working with Health Partners means that you will be working with a diverse range of people who are committed to doing things Side by Side. Visit http://careers.healthpartners.com.au/ to find out more about life at Health Partners. Applications will be screened as they are received. Health Partners appreciates the time and effort it takes to prepare and submit your application with us which is why we are a Circle Back Initiative employer and are committed to reviewing and responding to every candidate.If this role isn’t quite right for you but you recognise how your skills, experience and energy can become part of our next success, check out our website for all current vacancies and where you can also register for our talent pool. AUD Adelaide 5000

Claims Integrity Analyst

About Health Partners

We’re on South Australia’s side and have been for 85 years now. Our mission has been to bring about a better state of health by making it easier for South Australians to access the health care and support they need, while finding new ways to give back to the communities we call home. No matter where or how we grow, our focus will always be helping locals live in a better state of health.

We’re proud to be a not-for-profit – and prouder still to be guided by doing what’s right for our members, our people, and the broader community too. As South Australia’s largest open Health Insurer providing cover to over 90,000 people, we are on our members side for the moments that matter.

We are now seeking a Claims Integrity Analyst to join our team to provide support across a range of Provider Integrity business objectives and champion claims compliance!

About the role

The Claims Integrity Analyst plays a critical role in ensuring claims payments comply with legislation, fund and reasonability rules by developing and maintaining effective system controls and measures. With key focuses in system rules and maintenance, analysis and reporting and provider integrity support, this role provides a fantastic opportunity for a data analyst to contribute to various operational activities and business objectives within our Provider Integrity space.

Key responsibilities:

  • Updating benefit conditions within the relevant systems as required to ensure benefits are assessed correctly for new and existing products.
  • Providing advice to the business on any proposed changes to health fund products, particularly the required benefit conditions to support these changes.
  • Developing and maintaining claims compliance and reasonability rules in the relevant systems and search engines.
  • Developing and maintaining various data statistic reports and performing analysis to monitor risk and to inform on strategic and tactical activities.
  • Investigating and resolving issues with claims transactions.
  • Assisting with the testing of system changes related to Provider Integrity.
  • Participating in business plan activities and reviewing and updating procedure documentation as required.

About you

To be successful in the role you will have:

  • Bachelor of Data Analytics or relevant degree and/or relevant experience.
  • Private health insurance claim assessment and validation experience.
  • System based data analysis and reporting experience.
  • Knowledge of the Privacy Act and of the Medicare Benefit Schedule.
  • HCP data and ICD coding experience.
  • Proficiency in data query tools including SQL, Power Pivot, Power BI.

What’s on offer?

Generous employee benefits including:

  • Paid parental leave
  • Allowance on your private health insurance premium
  • Discounted sunglasses
  • Flexible and hybrid working
  • Access to internal and external learning
  • Volunteer days to work with our partner charities
  • Access to our Employee Assistance Program for you and your family
  • Access to discounted gym memberships and wellbeing programs

 

You must be an Australian citizen or permanent resident at the time of submitting your application, be able to provide two recent referees and hold a current satisfactory National Police Clearance (within 12 months) or be willing to obtain prior to commencement. 

Working with Health Partners means that you will be working with a diverse range of people who are committed to doing things Side by Side. 

Visit http://careers.healthpartners.com.au/ to find out more about life at Health Partners. 

Applications will be screened as they are received. 

Health Partners appreciates the time and effort it takes to prepare and submit your application with us which is why we are a Circle Back Initiative employer and are committed to reviewing and responding to every candidate.

If this role isn’t quite right for you but you recognise how your skills, experience and energy can become part of our next success, check out our website for all current vacancies and where you can also register for our talent pool.

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