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Medical Auditor

Job Requisition Number:  5863
Date:  10-Sep-2021


Will you actively create a healthier future for tomorrow?


At Medibank we’re encouraged to think big. We have a clear purpose to impact better health outcomes for our customers, patients and our community.


We celebrate diversity of thought because we want to make better decisions for our customers. As we work towards our goal of better health for better lives, we value the knowledge and contribution of Aboriginal and Torres Strait Islanders. We are working hard to create an inclusive workplace and develop Indigenous careers.


The Opportunity


We currently have an opportunity for a Medical Claims Auditor to join our Health Audit team.


Your key focus as a member of the Payment Integrity team will be to look for opportunities to limit improper claims, through prevention and investigation of fraud, waste, abuse and error. It is through this work, that we ensure premiums remain affordable for members in these uncertain times.


This role will initiate, implement and manage agreed audits that identify irregular medical billing, ensure compliance with industry guidelines and identify benefit leakage of medical claims.

The position will also play a key part in reporting on audit outcomes and driving implementation of requirements across the business to support audit functions. Please note that this is a 12 month contract.


In this role, you will have the opportunity to:

  • Support the Health Audit Innovation & Support Manager to develop and implement solutions to resolve erroneous claiming and inappropriate benefit outlays specifically relating to medical benefits/claims.

  • Maintain accurate and contemporaneous procedure manuals for allocated audit portfolio.

  • Assist employees across the Medibank Group in understanding key issues surrounding medical claim billing practices and the impact on business outcomes and effectiveness.

  • Assist Hospital Claims Staff to resolve provider related queries and claim issues.

  • Provide advice to clinicians and Medicare to resolve claiming disparities.

  • Support and mentor team members in developing knowledge and skills around medical billing.


In order to be successful in this role, you will ideally have:


  • Knowledge and understanding of the public and private health sectors particularly in relation to the Medicare Benefits Schedule including the application and rules surrounding inpatient medical service item numbers.

  • Experience working in billing or administration of medical services/claims such as accounts payable, or as an assessor in a specialist medical practice, Medicare, private hospital or private health insurer.

  • Demonstrated experience in preparing and analysing data for reporting purposes

  • Demonstrated commercial acumen in the interpretation of data and development of fact-based recommendations.

  • Demonstrated ability to think laterally to identify novel solutions to business problems.

  • A strong understanding of private and public hospital billing models (desirable).

  • Knowledge of medical claims assessing practices in a private health insurer (desirable).




A career with us

At Medibank, we believe work is something we do, not somewhere we go. Our modes of working – Collaboration, Connection and Concentration – help inform how your day is structured and where you choose to work will vary, depending on your role and requirements.


The wellbeing of our employees is our priority. We encourage you to talk to us about any adjustments or additional support you may require during the recruitment process, as well as how this role can be flexible for you. Virtual interviews are always on offer and will not adversely impact your application.


We offer a range of great benefits such as subsidised private health insurance, rewards and discounts, and health and wellbeing initiatives - click here to find out more.


To start small and impact bigger.

Job Segment: Accounts Payable, Audit, Medical, Claims, Medicare, Finance, Healthcare, Insurance