Clinical Analyst, Medical
At Bupa, purpose meets possible. Join us and help shape a future where healthcare is more connected, more personal and more human.
We’re a global healthcare leader trusted by millions and committed to helping people to live longer, healthier, happier lives and making a better world. Healthcare is changing, and so are we. We’re investing in more clinics, better systems and smarter, more connected ways to help our customers. As we continue to expand our services and invest in innovation, you’ll help create a healthcare system that meets people where they are, responds to what they need and leaves them better than before.
Here, your work has purpose, your voice matters and your future is full of possibility.
Just imagine the impact you could make.
The purpose of this job
The Clinical Analyst, Medical supports the Medical Integrity Lead in ensuring Bupa Health Insurance pays no more for services than it is contractually and clinically obligated to pay by identifying, investigating and addressing medical claims leakage and billing inaccuracies. The role is responsible for undertaking complex medical claims audits, including detailed review of itemisation, billing patterns, supporting documentation and clinical notes, to assess whether services billed are substantiated, appropriate and aligned to relevant billing rules and contractual requirements.
This role requires strong working knowledge of Medicare, MBS item numbers and descriptors, billing principles and provider claiming practices, together with the ability to engage directly with specialists, practice staff and provider rooms to clarify billing, documentation and clinical service issues. The role contributes to recoveries, prevention strategies, audit outcomes and broader integrity initiatives through high‑quality clinical review, provider interaction and subject matter expertise.
What you’ll need to make it possible:
- Degree-qualified in Nursing (or equivalent clinical discipline) with strong applied clinical knowledge relevant to medical claims review and audit.
- Demonstrated, practical understanding of Medicare, MBS billing rules and item numbers, and how these apply to medical claims and provider billing.
- Experience with medical claims audit in a health insurance or healthcare funding environment (advantageous).
- Experience successfully leading small teams to achieve strong KPIs (advantageous).
- Understanding of Medical Purchaser Provider Agreement contracts and medical claims processes (advantageous).
- Proficient in Excel and Word; experience with analytics and reporting tools such as Power BI or equivalent (advantageous).
- Strong stakeholder management and influencing skills, including with clinical specialists and practice staff.
What you’ll be doing in this role:
- Conduct complex audits and reviews of medical claims, provider billing patterns, item numbers, accounts and supporting clinical documentation to identify claims leakage, billing inaccuracies and inappropriate claiming.
- Review clinical notes and medical records to verify that services billed are clinically supported, accurately itemised and compliant with Medicare, MBS item numbers/descriptors and contractual requirements.
- Act as a clinical and billing escalation point for the claims integrity team, reviewing referred cases, providing clear guidance and decisions, and supporting uplift in their assessment capability.
- Manage complex provider interactions, including disputes and challenges to review findings, applying clinical evidence and billing rules to reach defensible outcomes. Initiate and support profiling reviews, desktop audits and targeted investigative activities within the agreed medical integrity work program.
- Analyse claims data, audit outcomes and provider trends to identify areas of current and emerging risk and contribute to reporting that informs medical claims leakage strategies and recovery activity.
- Apply subject matter expertise in Medicare, MBS billing rules and provider claiming practices to determine when further investigation, provider education, recovery or escalation is warranted.
Why you’ll love it?
We support our people to be the healthiest and happiest versions of themselves.
If this sounds exciting, we’d love to hear from you. Let’s shape the future of healthcare, together.
At Bupa your wellbeing, identity, and personal story are respected and valued. We are continuing to build teams that reflect the diversity of the communities we serve. Bupa is committed to providing equal opportunities and fostering a workplace and environment that is free of discrimination, bullying and harassment.
We actively encourage applicants from all backgrounds and experiences, including Aboriginal and Torres Strait Islander peoples, veterans, people with disabilities, and LGBTQIA+ applicants.
We are dedicated to removing barriers to participation. If you need any reasonable adjustments during the recruitment process, or if you’d like to discuss how this role can be flexible for you, please let us know so we can support your participation on an equitable basis.
