Job Description

Let’s Talk About Work That Actually Means Something

Our innovative model gives older Australians more choice, transparency, and value, helping them stay independent in their own homes for longer. But it’s not just about care - it’s about making a meaningful impact on lives and communities.

We’re a vibrant, forward-thinking team who take pride in creating an empowering, supportive workplace where ideas are valued, and people thrive. At Trilogy Care, you’ll join a purpose-driven organisation that blends heart with innovation, and creativity with real social impact.

The Claim Integrity Specialist is responsible for the accurate review and classification of invoices submitted through Trilogy Care's supplier network. This role ensures every claim is assessed against the Support at Home service list, AT-HM scheme eligibility criteria, and applicable program rules before submission to Services Australia. The role sits at the intersection of compliance, analytical rigour, and financial assurance -protecting both client funding integrity and Trilogy Care's obligations as a Category 5 approved provider.

What You’ll Do

• Review supplier invoices and assess alignment of goods and services against the Support at Home service list and AT-HM scheme eligibility criteria.
• Apply detailed knowledge of the Support at Home program to determine the correct service type and Tier 5 item code before submission to Services Australia.
• Identify and flag invoices that do not align with a client’s approved funding pathway, service agreement, or program rules.
• Maintain accuracy across bulk claim batches, applying consistent classification logic and escalating ambiguous or high-risk cases where required.
• Conduct secondary reviews of Tier 3 classifications and supplier-assigned codes, recommending corrections to ensure compliance and accuracy.
• Maintain up-to-date knowledge of the Support at Home program manual, AT-HM scheme guidelines, and Aged Care Rules 2025, serving as a reference point for internal teams.
• Identify process gaps, classification errors, or supplier coding issues and contribute to improvements in classification rules, QA workflows, and decision frameworks.
• Collaborate with Finance, Quality Operations, Data and Digital teams, providing guidance on classification decisions and supporting training, onboarding, and continuous improvement initiatives.

What You’ll Bring

• Tertiary qualification in health, aged care, business, or related field; OR demonstrated equivalent experience in a regulated claims, compliance, or quality assurance role.
• Strong analytical skills and exceptional attention to detail; able to work accurately across high-volume invoice datasets.
• Excellent written and verbal communication skills, including the ability to explain complex program rules clearly to diverse audiences.
• Proficiency with digital systems, including Large Language Models and Machine Learning; comfortable navigating multiple platforms, portals, spreadsheets, and data tools.
• Problem-solving mindset with a proactive approach to identifying gaps and escalating issues with proposed solutions.
• Ability to absorb and apply complex program rules and classification frameworks quickly and accurately.
• Demonstrated knowledge of, or ability to rapidly acquire expertise in, the Support at Home service list and AT-HM scheme.

Desirable:

• Familiarity with aged care or health funding and claims processes, including Services Australia portals, and knowledge of Aged Care Quality Standards or clinical governance frameworks.
• Experience with invoice review, claims processing, billing QA, or compliance checking in a regulated environment.
• Experience in a QA, audit, compliance, or review role within a health or government-funded services context.

Why Trilogy Care?

• Modern King Street, Bowen Hills office with excellent facilities, close to public transport, cafes, restaurants and supermarkets
• Vibrant team culture and regular social events
• Opportunities for career mapping and career progression within the company
• Salary packaging (Novated Leasing) to boost your take-home pay
• Access to Fitness Passport to support your health and wellbeing
• EAP support for you and your immediate family
• Employee discounts on groceries, fuel, utility bills, wellness and more

Unlock your Potential with Trilogy Care

Behind every hour of care we deliver is a smart, tech-enabled team rethinking how aged care operates. At Trilogy Care, we’re going beyond compliance and coordination – we’re applying AI, automation and operational design to deliver better client experiences and better employee ones. Every staff member has access to generative AI tools, training, and time to experiment - not just the Tech team! Whether you're in finance, people & culture, growth, or support, you’ll be part of an industry-first AI movement where we reward ideas that improve care outcomes, safety, efficiency or team wellbeing.

Please note

To join our team, you’ll need to have full Australian work rights. As part of our standard recruitment process, we’ll also conduct a working rights check, police check and request professional references during onboarding.

We appreciate the interest of recruitment agencies but kindly ask that resumes not be submitted unless a prior agreement is in place. Trilogy Care will not accept responsibility for any fees related to unsolicited resumes.