Manager – Hospital & Medical Integrity

As the Manager – Hospital & Medical Integrity the key focus of this role is to prevent leakage through the reduction of fraud, waste, abuse and error of hospital and medical claims. You will be responsible for managing the identification, mitigation, elimination and management of claim inaccuracy and leakage. The role demands a strong leader in the field of Private Health Insurance or from a Hospital Setting who has demonstrated the ability to take complex issues, resolve them in an innovative way and deliver on strong quantitative outcomes. This role will drive cost savings as a result of the development of hospital claims leakage activities including contract compliance, on site and desktop audits. There is a significant requirement to support and provide subject matter expertise uplift in systems implementation and analytics adoption to drive improved ROI How will I help?

Manage a team of auditors across hospital and medical utilisation, DRG audits and desktop audits wit...