Clinical Team Leader – Health Insurance Operations
Adelaide | Hybrid (min. 2 days in office) | Permanent
A senior leadership role within a high-volume, regulated health insurance environment, responsible for leading a team delivering clinical claims assessments.
The Role
Lead a team of 15–20 claims consultants responsible for pre-existing condition (PEC) and first-line clinical assessments. Accountability sits across operational performance, clinical quality, and compliance within a structured, fast-paced setting.
Act as the escalation point for complex clinical decisions while maintaining consistent delivery against service levels, quality standards, and regulatory requirements. Drive team performance through active workflow and queue management, coaching, and continuous improvement initiatives.
Operate with a strong focus on risk, governance and adherence to private health insurance legislation and internal frameworks. Lead through change, maintaining stability and performance in a high-demand environment.
Key Responsibilities
* Lead, coach, and develop a team of clinical claims consultants
* Manage workflow, queues, and daily operational performance
* Ensure high standards of clinical accuracy, quality, and compliance
* Act as escalation point for complex or high-risk clinical assessments
* Drive customer outcomes while balancing regulatory requirements
* Embed risk and governance practices aligned to PHI legislation
* Support and lead change initiatives across the function
About You
* Registered Nurse with 3–5+ years' clinical experience
* Proven leadership experience within health insurance, claims, or clinical operations
* Strong operational management capability in high-volume environments
* Experience managing performance, workflows, and service delivery metrics
* Sound understanding of compliance, risk and governance frameworks
* Ability to lead teams through change and drive consistent outcomes
What's on Offer
* Salary up to $140K–$160K base + super
* performance bonus
* Hybrid working model (minimum 2 days in office)
* Permanent, stable leadership opportunity
High-accountability role suited to leaders who can combine clinical judgement with operational execution in a regulated environment.
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