Medical Advisor
Brisbane, QLD, AU, 4000
Role Summary — Medical Advisor (Registered Nurse)
Location: Brisbane
Team: International Health (OSHC & OVHC)
This role sits at the intersection of clinical expertise, claims adjudication, and cost containment. The RN acts as a medical decision-maker ensuring appropriate treatment approvals and accurate claims assessment while managing high-cost cases and supporting non-clinical teams.
🎯 Core Purpose
- Assess and approve Guarantee of Payment (GOP) and treatment requests
- Adjudicate medical claims aligned to policy, MBS/PBS, and guidelines
- Manage high-cost cases (>$50K) with clinical and financial oversight
- Provide clinical guidance across the business
- Drive cost containment and governance
🧩 Key Responsibilities
1. Treatment Approval (GOP)
- Evaluate treatment requests against policy + Medicare frameworks
- Liaise with providers (public & private)
- Support internal teams with clinical interpretation
- Meet strict SLAs (48–72 hrs)
2. Claims Adjudication & Cost Management
- Review medical invoices and claims
- Apply MBS, PBS, AHSA, prostheses rules
- Identify cost-saving opportunities
- Advise on pre-existing conditions
- Maintain accurate documentation systems
3. High-Cost Case (HCC) Management
- Oversee complex claims >$50K
- Collaborate with Chief Medical Officer
- Attend case reviews and manage large exposures (>$100K)
- Ensure compliance with longer SLAs (5–30 days)
4. Stakeholder & Relationship Management
- Work with hospitals, providers, and internal teams
- Contribute to reporting and continuous improvement
- Support presentations and business updates
5. Data & Reporting
- Track referrals, cases, and high-cost claims
- Maintain SLA compliance across workflows
🧠 Technical & Clinical Expertise
- Strong understanding of:
- MBS, PBS
- OSHC & OVHC policies
- Private/Public hospital charging
- Ability to assess:
- Treatment appropriateness
- Clinical necessity
- Cost efficiency
✅ Ideal Candidate Profile
Must-Have
- Registered Nurse (AHPRA, unrestricted)
- Primary care or hospital experience
- Strong analytical and decision-making capability
- Excellent communication skills (clinical + non-clinical translation)
- Ability to manage workload under pressure
Highly Regarded
- Emergency nursing background
- Experience in:
- Health insurance
- Claims or utilisation review
- Case management
💡 What Makes This Role Unique
- Blend of clinical + corporate decision-making
- High exposure to complex cases and cost strategy
- Significant influence on medical spend and outcomes
- Opportunity to transition from bedside to strategic healthcare role
96830 | Physicians | Professional | Non-Executive | Allianz Partners | Full-Time | Temporary
Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us.
At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. And the foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion and trust.
We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.
Great to have you on board. Let's care for tomorrow.
