WW6625 - Payment Integrity Manager – Defence Health - Full-Time - Melbourne - VIC

  • Member Focused Not for Profit private health insurer
  • Develop a claims integrity plan and coordinate claims analysis
  • Join an Employer of Choice with a focus on employee wellbeing

Manage a team to deliver strategic goals by ensuring benefit payments are aligned to fund rules

About us

Defence Health provides great value private health insurance to the families of Australian Defence Force (ADF) members and the wider Defence community. As a Members Own Health Fund, we are not-for-profit and all for the benefit of our members. Our members really are just like family, and our team lives and breathes our service culture and corporate values – trust, respect, ownership, excellence and community.

Here at Defence Health we have a strong focus on staff engagement and supporting a high-performance culture. We recognise that a highly engaged and motivated team not only help us to retain fantastic people but enable us to provide a great member experience. But don't just take our word for it – Defence Health has been recognised as an Employer of Choice in the 2018 Australian Business Awards.

Find out more at www.defencehealth.com.au

Responsibilities / Duties: 

We have an exciting opportunity for a Payment Integrity Manager who will protect our members interests and that of Defence Health by ensuring benefit payments meet the necessary rules and requirements.
This role will be responsible for:

  • Development of annual claims integrity plan.
  • Claims analysis projects leading to enhanced benefits management.
  • Changes in processes and improvements in the core system to identify and
    prevent claims payable by third parties, claims errors, and potential fraudulent activities.
  • Analysis that aids Defence Health's understanding of trends in benefit 
    payments and how to curtail expenditure
  • Maximising the outcome and review of claims extracted based on third party analysis software.

This role is pivotal in supporting the onward strategic direction of the team and organisation. The ideal candidate will:

  • Have experience in medical terminology, understanding of MBS and DRG coding
  • The ability to conduct thorough investigations and analysis, and make recommendations
  • Demonstrate previous experience in leading teams and business functions
  • Be a proactive problem solver
  • Be flexible yet delivery focused
  • Possess strong attention to detail
  • Have excellent written & verbal communication skills
  • The ability to maintain positive and mutually beneficial relationships with both internal and external stakeholders

Experience in a Private Health Insurance setting desirable but not essential

Previous experience working with business intelligence software would also be an advantage.


Contact Name: Lauren McShane

Contact Title: HR Manager

Phone: 0386791136

Email: lauren.mcshane@defencehealth.com.au

Applications Close On: 
30 July 2019