Claims Audit Manager

TUH Health Fund

High performing Claims Audit team seeking experienced leader with expertise in auditing, data analysis and/or fraud identification

  • Use data and analytics to identify and stifle benefit leakage
  • Provide high level strategic insight and guidance
  • Develop anti-fraud strategies and policies
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
As the leader of our high performing Claims Audit team, you will report directly to the Executive Manager of Strategy and Finance. You will facilitate claims audit processes to identify claims leakage across hospital, medical and ancillary claims. Using data analytics to identify trends you will provide valuable insight into the assessment of products and advise on the risks associated with claims leakage.
In your new role you will
  • 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.
  • Provide strategic insight and guidance to management and stakeholders relating to the payment integrity of claims and trends associated with claims leakage.
  • Develop anti-fraud strategies and policies, and create a high level of awareness within the organisation.
  • Review, implement and ensure compliance with hospital and provider contracts
  • Manage relationship with Australian Health Service Alliance (AHSA), Australian Regional Health Group (ARHG) and provide input and coordinate responses to Private Healthcare Australia (PHA) requests.
About you
You have extensive experience in auditing, data analysis and/or fraud detection with demonstrated experience leading teams in leakage identification and the auditing and recovery of claims.
You have advance stakeholder relationship skills and a proven track record in using data to review, analyse and recommend solutions.  
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