Claims Risk Analyst

About us

Established in 1840, we are Australia’s first wellbeing company, delivering health, wealth and care services for our members and the community.

As a social enterprise, we are motivated by our purpose to positively impact the wellbeing of millions. We reinvest profits to deliver products and services sustainably that matter most to our members, customers and the Australian community.

For us, Real Wellbeing encompasses the whole experience of life. It is about feeling supported in your health, connected with your community and empowered to live life on your terms.

About the role

As a Claims Risk Analyst (Compensation), you will support Australian Unity’s claims management strategy by proactively assessing post payment compensation claims data to identify benefit outlay savings and recoveries. Reporting to the Senior Manager Claims Integrity, you will use analytical capability, fund rules, product knowledge and legislative knowledge to detect claims leakage, investigate inappropriate claims, and support timely recovery of monies paid in error or inappropriately.

In this role, you will:

• Manage compensation claims and support the management of the savings log

• Analyse data sets and reports to detect claims leakage and identify recovery opportunities

• Develop rules and flags to prevent repeat leakage issues

• Investigate and validate inappropriate claims across hospitals, members and providers

• Support timely recovery of monies paid inappropriately, including through error, over servicing, fraudulent activity or hospital upcoding

• Provide written and verbal responses to members, lawyers and third party insurers using fund rules, product and legislative knowledge

• Maintain high quality written communication that meets Australian Unity standards and complies with fund rules and relevant legislation

• Implement, update and maintain templates, procedures and protocols for different claims leakage types

• Ensure processes are clearly documented and identify control gaps with recommendations for improvement

• Contribute to a customer centric culture and support ways to listen, learn and respond to feedback

• Adhere to risk, compliance, information security and workplace health and safety obligations and complete required training

About you

• Strong analytical skills with the ability to interpret data sets and identify patterns and anomalies

• Knowledge of business fund rules, product knowledge and relevant legislation, with the ability to apply these to claims decisions and communications

• Strong investigation skills and attention to detail, including validating claims and documenting outcomes

• Confident communicator with a high standard of written communication suitable for members and external parties

• Process and control mindset with experience improving templates, procedures or protocols

• Ability to take ownership of work, manage priorities and contribute to team outcomes

What’s on offer

You will enjoy a range of great employee benefits and rewards including:

• Competitive salary + bonus program

• Enjoy additional yearly Well-Being and Community leave days

• 14-week paid parental leave, with equal benefit for both parents

• Employee Referral Program

• Employee Assistance Program – support and assistance for you and your partner at those times in life when you need it most

• Maxxia Rewards - a great range of discounts and benefits at selected retail outlets, department stores, attractions, travel, cinemas, restaurants

• Discounts across the Australian Unity business including Private Health Insurance, General Insurance + more

• Available access to LinkedIn Learning courses through our great Learning platform

For further benefits visit: https://www.australianunity.com.au/careers/culture

Australian Unity is an Equal Opportunity employer and we encourage applications from all members of the community, including people of Aboriginal and Torres strait Islander descent, culturally and linguistically diverse backgrounds and mature aged people.