Clinical Adviser & Claims Auditor

AIA Australia
    Sydney, Melbourne, Australia
    Job Type
    Application Close Date
    Contact Name
    Lisa Cronan
    Contact Email
    Contact Phone


    At AIA we don’t simply believe in being ‘the best’. We believe in better – because there’s no limit to how far ‘better’ can take us. Everything we do is driven by our purpose to make a difference by helping people embrace Healthier, Longer, Better Lives. And every one of our people has an important part to play. If you want to make a difference by helping shape a healthier, better-protected Australia, read on.
    The opportunity:
    We have an opportunity available for a Clinical Adviser and Claims Auditor to support our Health Insurance function at AIA. Based in either Melbourne or Sydney, the focus of this role is to ensure the ongoing and productive auditing of hospital, medical and ancillary claims as required by the business. Furthermore, you will provide clinical advice to assessors and the business and take ownership of recovering overpaid funds.
    To do this successfully you will:

    • Complete clinical advice & claims auditing to support the claims department and assessors
    • Drive continuous improvement of processes and systems, ensuring accuracy and compliance
    • Ensure audits conducted are compliant with PHI Rules, Contract Agreements and Schedules, HICAPS Terms and Conditions, Fund Rules and other policy requirements of the business
    • Assist the Customer Service Team Managers in implementing policies, procedures, guidelines and audit schedules
    • Contribute to AIA overall claims leakage strategic plan and objectives through planning own work and timely attendance to all delegated tasks and functions
    • Consider problems or issues that may arise and use lateral thinking to resolve or recommend solutions
    • Provide clinical advice to assessors and business where required
    • Liaise with hospital and provider billing teams as required to undertake the audit function effectively

    Successful applications will demonstrate:

    • Experience working with PHI Hospital and Ancillary claim data
    • Degree Qualification in Health Information Management (HIM) or successful completion of HIMAA clinical coding course
    • Coding experience with knowledge of ICD-10-AM (11th edition), ACHI & ACS
    • Knowledge of private sector funding models
    • The ability to read and understand claims data and medical records with the ability to determine where inconsistencies and/or outliers have occurred
    • Excellent organisational and time management skills, including demonstrated experience in coordinating input from a number of contributors
    • Effective consulting and stakeholder management skills.

    Why choose AIA:
    At AIA, we’ve made a promise to help people live healthier, longer, better lives. And it starts with our own people.

    • Access our training and development to build on your current skills
    • Career development through internal mobility opportunities
    • Work for a business helping millions of Australians and make a difference to someone’s life everyday
    • Access additional leave days a year to recharge and refresh yourself
    • Enjoy wonderful Health and Wellbeing initiatives that support you
    • Work with supportive and inclusive managers
    • Flexible working arrangement

    At AIA Australia, we’re proud to help guide, support and protect the wellbeing of over 3.5 million Australians. Through life and health insurance, financial wellbeing and our total wellbeing ecosystem that includes AIA Vitality – the world’s leading science-backed wellbeing program – we’ve started a movement to make Australia the healthiest, best protected nation in the world.
    As part of the AIA Group - the largest independent publicly listed pan-Asian life insurance group with a presence in 18 markets in Asia-Pacific – it is our ambition to engage one billion people to live Healthier, Longer, Better Lives by 2030.  Lots of companies like to say they’re different. What makes us truly different at AIA, is the difference we make in people’s lives.
    AIA is different. Are you?
    If you want to be part of an organisation that helps people live better every single day, apply via the link prior to applications closing on Friday, 2 June 2023.

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