- Agreement Monitoring: Monitor and analyze agreements with hospital groups, individual hospitals, and service providers.
- Contract Administration: Oversee the administration of contracts with an assigned portfolio of hospital providers.
- Renewal and Execution: Participate in the renewal and execution of agreements with providers, working alongside Hospital Relationship Managers.
- Benefit Outlay Management: Actively monitor HCF benefit outlays through performance management of providers.
- Stakeholder Engagement: Develop and maintain effective relationships with key stakeholders.
- Positive Behaviors: Promote positive, collaborative, and productive relationships with providers and industry partners.
- Strategic Planning: Assist in developing and implementing Hospital & Medical Benefits (HMB) Purchasing and Network Strategies.
- Claims Assessment: Review exceptional payment requests, advise providers on funding decisions, and provide expert opinions to HCF stakeholders.
- Complaint Handling: Investigate and respond to provider complaints assigned to HMB, including those lodged through Private Health Insurance Ombudsman.
- Provider Applications: Assess applications from providers seeking agreements with HCF, coordinating financial and clinical reviews, and providing rate proposals.
- Performance Monitoring : Implement audit and performance management programs to monitor provider compliance with obligations.
- Benefit Outlay Trends: Monitor benefit outlay trends of providers individually and collectively, ensuring compliance with budgeted outcomes and projections.
- Reporting and Analysis: Provide detailed analysis of Hospital Benefit costs per Single Equivalent Unit (SEU) to HCF Executive.
- Default Rates and Schedules : Prepare second-tier default rates and schedules.
- Claims System Maintenance : Maintain hospital rates within claims assessment systems.
- Contractual Records : Ensure maintenance of contractual records and documentation, including correspondence and contract library.
- Provider Agreement Renewal: Participate in the renewal of provider agreements in partnership with Hospital Relationship Managers.
- Knowledge of Health and Private Health Insurance Industry particularly in relation to hospital agreement renewals, contract administration, planning and implementation.
- Knowledge of PHI regulation and legislation e.g. Benefits Requirements Rules, Medical Devices and Human Tissue Items Prescribed List, MBS.
- Demonstrated experience in monitoring performance and developing reports for executive.
- Demonstrated experience working collaboratively with senior executive on leading the implementation of complex change programs.
- Excellent communication skills, with the ability to convey a coherent argument through the delivery of contract proposals, reports and presentations.
- Excellent numeracy skills, with the ability to analyse, interpret data to identify trends and underpin hypotheses.
- Proficient in Microsoft Word and Excel, with the ability to create pivot tables and use basic formulae to facilitate analysis.
- Solution orientated with the ability to systematically analyse data and information to inform decision making.
- Advanced organisational skills and effective time management.
- Tertiary qualifications in business, finance or health information management would be advantageous
- 50% subsidy on HCF Private Health Insurance
- 18 weeks Parental Leave for all new parents
- Mental Health & Wellbeing programs
- Discounts to HCF's entire suite of products; Life, Pet and Travel Insurances
Senior Hospital Benefits Manager - Sydney, Australia - HCF Australia
Description
About HCF
At HCF, our purpose is to bring our human touch to healthcare. Since 1932 we've been putting our members and their health first. As Australia's largest not-for-profit health fund, we cover over 1.7 million members with health, life, travel and pet insurance and our vision is to make healthcare understandable, affordable, high quality and member centric.
About the Role:
As the Senior Hospital Benefits Manager at HCF, you will play a crucial role in ensuring the effective performance of our agreements with hospital groups, individual hospitals, and providers of services. Your responsibilities will include monitoring and analysing these agreements, overseeing contract administration, and actively managing benefit outlays. You'll collaborate closely with Hospital Relationship Managers to renew and execute agreements, while also exploring strategic partnership opportunities.
Key Responsibilities:
Qualifications and Experience:
Culture & Benefits
Working in the health insurance industry, we know how important it is to prioritise the wellbeing of our own people. We want to provide you with the skills and tools you need to support your own wellbeing journey, so that you can be at your best. This includes:
Growing your career at HCF is a priority for us. To support your growth and development we have many learning opportunities internally and externally with study leave and study assistance to further support.
HCF is committed to maintaining an inclusive and collaborative work environment. We aim to have a workplace that is welcoming and safe for all our employees, irrespective of their unique characteristics including age, ethnicity, cultural or spiritual background, gender identity, disability, education, and socio-economic status. All suitably qualified applicants will receive equal and fair consideration for employment. All potentially successful candidates will be required to complete background checks prior to confirmation of employment. If you require any adjustments to assist you in making your application or throughout the recruitment or onboarding process, please reach out to Talent Acquisition – to discuss.
We encourage applicants to submit their applications at their earliest convenience, as at HCF, we review applications as they are submitted, and may have filled the role prior to the job closing date.