Claims Officer

Full job description
Join Australia's largest not for profit health insurer.
About the Role


As a Hospital Claims Officer, you will be responsible for processing high volume hospital claims. This role has a strong customer service focus, and it is essential that accurate information and exceptional service in provided responding to enquiries raised by internal customers, members, Medicare Australia and providers. A thorough understanding of the funds policies and procedures are required.

This role is a full time, permanent role based at the Parramatta contact centre with hybrid working available.


Key responsibilities will include:
Assess and review all types of hospital claims
Review and pay medical 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
Registering Medicover providers and updating provider details, maintain medical provider records and contract details
Processing of No Gap & Known Gap Medical claims using “PreMac” User interface
Process rejected, refused, suspended and adjusted claims, using WHICS system
Maintain medical provider records and contract details
Perform medical claims adjustments and initiate follow up/recovery action as required
Action reports and perform quality review processes as required
Proactively respond to enquiries from Medicare Australia and providers.
About You

You will have strong customer service skills and previous experience within claims, call centre or administration roles. To be successful, you will have:
Intermediate PC skills with accurate data entry skills
Ability to adapt positively to changing work practices and needs
Proficient understanding of WHICS, ECLIPSE, “PreMac” especially in relation to reassessments and claims processing
Ability to set own priorities to ensure individual and team targets are achieved / exceeded
Ability to communicate verbally effectively and courteously and in writing to both internal and external customers
Ability to work autonomously and set own priorities to ensure unit objectives are met.

About HCF

At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we’ve been putting our members and their health first. As Australia’s largest not-for-profit health fund, we cover 2 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member centric.

We want to be true health partners to our members, easily guiding the healthcare choices that are right for them. At HCF, our values are the way we do things and create the necessary culture to help us realise our purpose and deliver our Strategy. Living our values in action we step forward, walk in their shoes, stay human, make it better and get there together.

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:
50% subsidy on HCF hospital and/or extras cover
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. HCF provides opportunities for personal and professional development. From workshops to mentorship programs, we encourage your growth and curiosity.
Next steps

If you require any adjustments to assist you in making your application or during the recruitment or onboarding process, please reach out to Talent Acquisition –
peopleservices@hcf.com.au
to discuss.

We encourage applicants to submit their applications at their earliest convenience, as at HCF, we review applications