Job Title

Are you looking to apply your expert clinical knowledge in a new and different environment? Do you want to work for somewhere that truly makes a difference in SA? Were looking for a Clinical Advisor to join our team at 0.6FTE to apply their clinical expertise in the claims process and help our members get the best possible outcomes. About Health Partners Were more than just your health partner. As a proud South Aussie not-for-profit, weve had our members backs (and eyes, and teeth) for over 85 years. This means we know health and wellbeing looks different for everyone, and its why were on a mission to create a better state of health for our over 95,000 members and the local community we call home. As a member-owned fund, were guided by doing whats right for our members, our people and the broader community. To be a Health Partners member means youre part of something pretty special were your truly local, value giving, member satisfying partner. About the role Youll sit at the heart of our health insurance operations, partnering closely with the Claims Team to bring expert clinical insight to every stage of the claims journey. Youll review services being claimed to ensure they meet clinical compliance standards and align with best-practice care - helping drive accurate, fair, and confident decisions. Key responsibilities Be the clinical mind behind claims decisions - supporting adjudication while keeping everything aligned with contracts, legislation, business rules, and fund requirements. Partner with the Claims team to confidently connect with hospitals, doctors, and clinicians, whether its clarifying details, requesting more info, or explaining assessment outcomes. Get ahead of the curve by assessing risks linked to new medical technologies and helping design practical solutions to manage them. Team up with external stakeholders to untangle complex cases and keep the claims journey moving smoothly from start to finish. Build strong, respectful relationships with providers and consultants to gather the right information and keep collaboration flowing. Share your expertise across the business, delivering clinical insight, clear interpretation, and industry know-how to support smarter decisions everywhere. About you Youre a confident clinician who knows your craft - and you have a talent for translating complex ideas into clear, engaging insights for audiences without a clinical background. You also have: Registered Nurse qualifications (RN, NP or equivalent) with real-world clinical experience - whether thats hospital life, private practice, or a specialty setting. Youre confident navigating medical terminology, from treatment pathways and disease processes to guidelines and how the healthcare system really works. A natural critical thinker who can connect the dots, solve problems, and collaborate smoothly with multidisciplinary and organisational teams. Comfortable diving into the detail - confidently interpreting clinical data, medical records, contracts, and insurance claims. A people person with standout communication skills who knows how to engage, influence, and bring stakeholders along for the ride. Familiarity with PHI regulatory bodies (e.g. APRA, ACCC, Department of Health) is a bonus, but not a necessity! Whats on offer? To be part of our local team means youre part of something pretty special. Youll be working with a diverse range of people who are committed to doing things Side by Side. Head to to find out more about life at Health Partners and Side by Side, our employee value proposition. Working for us means you can also access our generous employee benefits, including: Paid parental leave Allowance on your private health insurance premium Family & Friends private health insurance discount Flexible and hybrid working experiences Access to internal and external learning Volunteer days to work with our partner charities (currently Foodbank, Treasure Boxes and KickStart for Kids) Access to our Employee Assistance Program for you and your family Access to discounted gym memberships and wellbeing programs. You must be an Australian citizen or permanent resident at the time of submitting your application and hold a current satisfactory National Police Clearance (within 12 months) or be willing to obtain prior to commencement. Are you interested? Apply today! Send through your application. Well screen applications as theyre received, so be sure to get in fast. We appreciate the time and effort it takes to prepare and submit your application with us. This is why were a Circle Back Initiative employer, committed to reviewing and responding to every candidate. If this role isnt quite right for you, but youve got the skills, experience or energy to elevate our team, check out our website for all current vacancies and register for our talent pool. #J-18808-Ljbffr