Permanent Opportunity | Adelaide | Hybrid | Lead Clinical Claims Decision-Making

Bupa is seeking an experienced Clinical Team Leader to join our Health Insurance Operations team in Adelaide. This is an exciting permanent leadership opportunity to apply your clinical expertise while leading a high-performing claims assessment team responsible for fair, accurate, and timely healthcare decisions that impact more than 4 million Australians.

In this role, you will combine clinical knowledge, operational leadership, and regulatory governance to support high-quality decision-making within a fast-paced private health insurance environment.

The Opportunity

As a Clinical Team Leader, you will lead a team of approximately 15–20 claims consultants responsible for pre-existing condition (PEC) evaluations and first-line clinical assessments within our Hospital and Medical Claims operations.

Leveraging your clinical background as a Registered Nurse, you will provide guidance on lower-complexity clinical decisions, strengthen the team’s capability in applying structured clinical frameworks, and ensure assessments are completed accurately and in compliance with legislation and internal policies.

You will:

• Lead, coach, and develop a team of claims consultants to deliver consistent, high-quality assessment outcomes
• Foster a positive, psychologically safe and customer-focused team culture
• Manage daily operational workflow including queue management, resource allocation, and service delivery targets
• Act as the first escalation point for clinical assessment decisions and complex member matters
• Ensure claims assessments align with Private Health Insurance legislation, fund rules, and clinical decision frameworks
• Monitor productivity, quality, and compliance across the team while driving operational excellence
• Identify risks, incidents, and improvement opportunities to strengthen governance and decision-making processes
• Collaborate with Clinical Leadership, Medical Advisors, and Claims Operations teams to optimise workflows and improve service delivery
• Analyse trends in PEC decisions, complaints, and quality outcomes to inform training, process improvements, and automation initiatives
• Support organisational change initiatives and continuous improvement programs

Ideal Candidate Background

The ideal candidate will bring a strong clinical foundation combined with operational leadership experience within health insurance, claims operations, or another regulated environment.

You will likely have experience leading teams responsible for claims assessments, case management, or healthcare decision-making and be comfortable operating in a high-volume operational environment with strong governance requirements.

Candidates with experience in private health insurance, insurance claims operations, or healthcare governance environments will be particularly well positioned to succeed in this role.

About You

You are a confident clinical leader who combines sound clinical judgement with strong operational management capability.

You will bring:

• Current AHPRA registration as a Registered Nurse
• Minimum 3–5 years applied nursing experience
• 3–5+ years leadership experience managing operational teams in health insurance, claims, underwriting, or regulated environments
• Experience managing team performance, productivity, and quality outcomes
• Ability to guide non-clinical teams in applying structured clinical decision frameworks
• Strong understanding of risk management, compliance, and regulatory obligations
• Excellent communication skills with the ability to explain complex clinical or regulatory requirements clearly
• Experience managing customer escalations, complaints, and operational risk
• A collaborative leadership style with the ability to partner effectively with clinical and operational stakeholders
• A continuous improvement mindset with exposure to process optimisation, workflow management, or automation initiatives

Highly desirable:

• Knowledge of Private Health Insurance legislation and PEC rules
• Experience working with clinical advisors or medical governance teams

Why Join Bupa

• Hybrid working (2 days in office / 3 days from home) for flexibility and collaboration
• Fully subsidised Bupa health insurance
• Additional annual wellbeing day and paid volunteer leave
• Access to global wellbeing programs and lifestyle discounts
• Opportunity to work on high-impact remediation and transformation initiatives across the business

Our Commitment

Bupa values diversity, inclusion, and fair outcomes for customers. We encourage applications from all backgrounds, including First Nations peoples, veterans, people with disabilities, and LGBTQIA+ communities. Adjustments during the recruitment process can be supported.