Payment Integrity Specialist in Australia Fair, Queensland at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Payment Integrity Specialist in Australia.

This role sits within a specialized healthcare finance and audit function focused on ensuring the accuracy and integrity of private health insurance claims. You will play a key part in reviewing, analysing, and auditing hospital billing and clinical documentation to identify overpayments and support recovery efforts. Working remotely within Australia, you will collaborate closely with internal teams and contribute insights that improve claims detection systems and compliance processes. The position combines clinical knowledge with analytical auditing expertise, requiring a strong understanding of healthcare funding models and coding standards. You will also engage with stakeholders to enhance billing transparency and support continuous improvement across payment integrity operations. This is a detail-driven role with direct impact on financial accuracy and system efficiency in the healthcare sector.

• Conduct audits of private hospital claims to identify inaccuracies and recover overpayments for health insurance clients.
• Review and assess clinical documentation provided by healthcare providers to ensure compliance and accuracy.
• Analyse hospital billing practices and provide actionable insights to improve detection and recovery of incorrect claims.
• Support the enhancement of payment integrity processes and tools through feedback and operational insights.
• Collaborate with internal teams to strengthen compliance frameworks and claims review methodologies.
• Contribute to business development initiatives by supporting the growth and positioning of the payment integrity function.
• Maintain strict confidentiality when handling sensitive clinical, financial, and client information.

• Bachelor’s degree in Nursing (or equivalent clinical qualification) with experience in critical care, emergency, or operating theatre settings preferred.
• Qualification or experience as a Health Information Manager or Clinical Coder (5–8 years of experience).
• Strong background in auditing private hospital claims or working within private health insurance environments.
• Solid understanding of private health insurance legislation and hospital funding models.
• Clinical coding experience and familiarity with tools such as 3M CodeFinder is highly desirable.
• Strong analytical and attention-to-detail skills with the ability to interpret complex clinical and billing data.
• Excellent written and verbal communication skills for reporting and stakeholder engagement.
• Strong organizational and time management skills with the ability to manage workload independently in a remote environment.
• Commitment to continuous learning and maintaining up-to-date clinical and coding knowledge.
• Ability to work effectively from a home office within Australia.

• Fully remote role within Australia
• Opportunity to work in a specialized healthcare payment integrity function
• Exposure to leading practices in claims auditing and healthcare analytics
• Collaborative and expert-driven professional environment
• Contribution to improving fairness and accuracy in healthcare funding systems
• Ongoing professional development and continuous learning opportunities
• Meaningful impact on healthcare cost integrity and system efficiency