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Claims Audit And Contracts Manager

TUH Health Fund - Fortitude Valley, QLD

Source: uWorkin


Full Job Description
Work for a Not-for-Profit organisation where our people are our main asset
Give data driven insights, manage key relationships & review contractual changes
Facilitate claims audit processes to identify claims leakage and inform strategy

Taking care of more than business
At TUH, there’s nothing more important to us than taking care of the people who take care of our members. After all, our members deserve to have the most dedicated and passionate people backing them all the way. And so do you.

Not only will we support your appetite to grow and explore your career possibilities, our focus is also on creating healthier and happier employees. You will have access to an impressive suite of health and well-being benefits, genuine flexible working options, and a fun and respectful workplace culture where everyone has an eye out for each other.

The impact you could make
With a direct reporting line to the Executive Manager of Strategy and Finance, you will support the success of TUH by leading our high performing Claims Audit team, and providing strategic insights to management on factors impacting claims leakage. In this role you will take the lead in managing hospital and medical contracts that are paramount to our operations as a Private Health Fund, and the relationships with stakeholders for which they relate. You will also lead the Claims Audit team in embedding strategies to identify and mitigate claims leakage across hospital, medical and ancillary claims. Leveraging the knowledge of your expert team, and robust data analytics processes, you will identify and predict impacts of government, industry and business changes to claims behaviours.

In this Permanent Full-Time role you will:
Assist the Executive Manager, Strategy and Finance in the execution of strategic business plans in line with TUH’s purpose, vision and mission
Lead the Claims Audit team in the day-to-day claims auditing and benefit leakage initiatives, including the management of complex audits, with a focus on addressing provider behaviour while maintaining beneficial provider relationships and positive member experiences.
Manage relationships with key claims contracts suppliers, and provide feedback, advice and recommendations, where appropriate in relation to related contract matters.
Facilitate and provide strategic insights to management on changes to claims related legislation, regulations and contract and the impacts on TUH operations.
Analyse claims information, provide input and coordinate responses to industry association requests, including matters relating to the Department of Health.
Develop, monitor and implement data analytics processes to identify patterns of inappropriate claiming, drive audit initiatives and improve efficiencies to reduce claims leakage
Provide strategic insights and advice to management on provider behaviour and intelligence on factors influencing claims leakage
Prepare and deliver reports on team outcomes, initiatives and proposals.
Facilitate a highly engaged, high performance Claims Audit function through well-developed people management practices, in line with TUH’s culture

About you
Your advanced interpersonal skills have seen you succeed in managing complex stakeholder relationships for mutually beneficial outcomes. You are a strategic thinker and skilled-problem solver, comfortable extracting, synthesising and analysing data to support your decision-making. These skills have come from your experience working in the financial services or health industry, in roles responsible for business analysis, contract management and/or statistics, and your tertiary qualifications in a related field. You're passionate about educating and leading teams in auditing and managing claims leakage activities and are also well-versed in interpreting legislation and contracts within a regulated industry setting.

An understanding of the rules and regulations within the private health fund industry is desirable but not essential.

Live as well as you work
You’d be surprised if we didn’t practice what we preach, which is why our focus on our employees’ health & wellbeing is just as important as our members’.
There’s so much on offer that we don’t have space to list all of the benefits, but here are a few of the highlights:

Additional superannuation contributions
An industry award nominated health and wellbeing program, that includes subsidised gym membership, a games lounge, free flu shots, free health screens, and more, so you know you're in good hands.
Private Health Insurance benefit
Flexible working arrangements
Learning and development opportunities
So what are you waiting for? Submit your application today!

Please note: TUH is committed to quality, in-house recruitment and as such will not be accepting agency applications or canvassing