Where did you grow up?
I grew up in the Geelong area and attended Geelong High School, graduating in 2006. At the time, I wasn’t exactly sure what I wanted to do for a career.
I chose a double degree in Arts/ Arts Education at La Trobe University. I thought being a teacher would mean I would always be employable, and I loved studying history, English and politics at high school.
Unfortunately, after a few sets of teaching rounds, I realised teaching was most not for me! Using my education courses as my electives, I graduated with an Arts degree (with the obligatory one-year gap year working and backpacking in Europe). During the last year of Arts degree, I had a fantastic lecturer who was passionate about European politics, who discussed the possibility of studying abroad and writing a thesis on a topic of interest, so I studied for my Honours degree in the Netherlands and at the Maastricht University’s Centre for European Studies.
Why did you apply for your first role at GMHBA? What was it that interested you about working here?
After graduation, I still did not know what I wanted to do when “I grew up.” My mother had previously worked in the fraud department at Centrelink (Department for Human Services) and this seemed interesting, so I applied and worked there for a short time but quickly realised this was not for me so thought I would explore my passion for travel, working at Flight Centre. Another six months later, I realised again, this was not for me and decided to pursue a Master of Information Management with the end goal of working in libraries or academia.
It was at this time I realised I would need a part-time job, so applied for an opening in the “Customer Service Centre” at GMHBA in 2014. After working at Centrelink, dealing with GMHBA’s members was decidedly a breeze. I thoroughly looked forward to coming to GMHBA each day, as the culture of the Customer Service Centre was wonderful. All the staff were so friendly, and fun and genuinely tried to do the best for our members each and every day. I remember when I first started, we had just introduced IVR, the voice recording to say “Press One if you are an existing member” etc, which was a big change at the time.
What were your next roles….
After eleven months, a maternity leave replacement role opened in the Audit team, and given my previous interest in fraud, I applied for and ended up in this ancillary audit role. From my first weeks in this department, I was fascinated. Investigating fraud, erroneous or incorrect claims/policies was hugely interesting, and with the added benefit of feeling like I was making a difference by saving GMHBA members contributions. Every dollar I had returned that had been paid out incorrectly was one less dollar that our members would have to contribute.
When the maternity leave replacement was coming to an end, GMHBA were amid acquiring health.com.au, so it was a natural fit for me to start an ancillary audit team (of one; me) at health.com.au. They had not previously conducted any formal ancillary audit or claim investigations; within weeks I had discovered tens of thousands of dollars worth of fraud and claim leakage.
How were your early roles here helpful in terms of your career progression?
In 2018, an opportunity had arisen to cross-skill in hospital and medical auditing. I had no clinical knowledge, however, was very familiar with GMHBA operating systems, level of cover and fund rules, and had picked up second-hand knowledge of hospital and medical claim auditing through listening to our Health Information Managers. It was daunting at first, but I was so well supported by the rest of the Audit team and soon found there was not much I couldn’t learn by asking my teammates, or from Google. Deciphering doctors handwriting on op reports is still a skill I have not mastered though! Piecing together bits of information from coding, contracts, and hospital documentation (as well as saving our members over a million dollars a year) was hugely rewarding.
What do you do in your current role as Project Manager / Why is this important to GMHBA?
In 2021, our team of auditors had grown from four to twelve, and I was successful in becoming the new Team Leader- Payment Integrity (hospital and medical).
My Master’s degree assisted me with this transition, having to deal with a significant amount of data daily, as well as introducing me to project management methodologies. I have always had an analytic and investigative mindset, and I was lucky enough to be introduced to this area of work at GMHBA. Had I known being a Health Information Manager was a career back in 2006, it may have been something I would have pursued.
What do you enjoy about your current role?
Despite the cliché, I do love how different each day can be. I can spend one day deep in audits, having picked up a prosthesis billing error, and then proceed to pull data on every time this prosthesis has been billed incorrectly and request this money to be returned to GMHBA.
What is interesting about Private Health Insurance? What keeps you coming in to work each day?
Alternatively, I can be helping review cases with one of my team members, working on development plans, negotiating compensation payments from lawyers on behalf of GMHBA, or working through process improvements to our current system. A large project I have previously worked on was our Case Management System-working with our Benefits Management Squad to assist with the development of Benefits Audit, which ended up increasing audit productively by 243%. This was a massive project and involved a cross functional team and a significant investment of time and talent. This system allowed our team to increase its efficiencies, reduce our average length of cases, increase our overall savings, and dramatically improve reporting and result tracking.
How has your degree been useful in the various roles that you’ve undertaken at GMHBA?
When I started in the Audit team, we had potential identified savings of $5.8 million dollars for FY15. We ended FY22 with potential identified savings of $12.6 million- and again, every dollar we prevent or have refunded to GMHBA saves our members- the work the payments integrity team does every day really matters!
3 pieces of advice you’d give to Graduates wanting to join our organisation?