Clinical Integrity Specialist
- Perth
- Permanent
- Fri May 15 10:01:49 2026
- JR100168
At HBF, we’re all about delivering for our members in the moments that matter and our Clinical Integrity Specialists play a critical role in making sure every claim stacks up clinically, contractually and ethically.
The Clinical Integrity Specialist helps support HBF’s strategic goals by reviewing hospital claims to assess their accuracy and compliance with contracts, regulations, and industry standards. Where needed, they’ll also initiate recovery of any benefits that have been incorrectly paid. The key responsibilities of this role include:
- Reviewing hospital and medical claims to ensure compliance with regulations, contracts, and industry standards.
- Investigating clinical claims and medical records to confirm accuracy and member eligibility.
- Identifying claim anomalies, reduce financial loss, and support benefit recovery efforts.
- Developing and applying system rules to flag high-risk claims before payment.
- Building and maintaining professional relationships with healthcare providers during investigations.
- Maintaining clear, compliant procedures for clinical claim assessment.
- Providing clinical expertise and training to internal teams and external stakeholders.
- Contributing to performance reporting, audits, and strategic projects.
About You
We are looking for someone who has come from a clinical background and has had experience being a primary decision maker, ideally in management roles. You’re naturally curious, comfortable digging into the detail, and confident backing your judgement when it matters. Ideally, you will have;
- A degree in Nursing, with extensive post-graduate or equivalent experience within a wide range of clinical specialties
- Excellent written and verbal communication skills, including report writing and presentation delivery
- Strong interpersonal skills with the ability to build relationships, influence stakeholders, and handle sensitive situations with empathy.
- Solid analytical skills, including proficiency in Microsoft Excel.
- Ability to explain clinical concepts clearly to non-clinical audiences.
- Knowledge of the private health insurance industry, including hospital invoicing and claiming processes (prior experience in health insurance or as a Nurse Unit Manager is highly regarded).
Why Join HBF?
At HBF, we’re committed to creating a workplace where people feel supported, valued and able to do their best work. As part of our People team, you’ll have the opportunity to contribute to meaningful work that supports our people and strengthens our organisation.
You’ll join a team that’s brave and collaborative with opportunities to grow your career while contributing to work that truly matters as well as:
- Fully subsidised Gold Hospital Insurance Cover
- Flexible working and work from home options
- 3 additional wellbeing days each year (on top of our standard 20 days annual and 10 days personal leave)
- 2 volunteering days per year
- Onsite Barista with subsidised coffee
- Access to corporate discounts across a range of gyms, retail, restaurants and hotels
Next Steps
To apply, click on the “Apply Now" button to complete your application and send through a copy of your CV outlining your skills and experience in relation to this role.
At HBF, we believe in the unique potential of every individual. We’re committed to building an inclusive workplace where diverse perspectives are valued and celebrated, because they make us stronger.
We encourage applications from all backgrounds, including Aboriginal and Torres Strait Islander peoples, people with disabilities and members of the LGBTQIA+ community.
We want you to Be You, Be Bold, and feel supported every step of the way. If you need any adjustments during the recruitment process, please contact us at careers@hbf.com.au so we can work together to accommodate your needs.
Discover how we’re making a difference, explore our Community Initiatives at: Community Initiatives | HBF Health Insurance
