Medical Advisor

Job description

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 Key Responsibilities 1. Treatment Approval (GOP) 2. Claims Adjudication & Cost Management 3. High-Cost Case (HCC) Management 4. Stakeholder & Relationship Management 5. Data & Reporting Technical & Clinical Expertise ✅ Ideal Candidate Profile - 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 - Evaluate treatment requests against policy + Medicare frameworks - Liaise with providers (public & private) - Support internal teams with clinical interpretation - Meet strict SLAs (48–72 hrs) - Review medical invoices and claims - Apply MBS, PBS, AH...