Job Description

Help Us Shape the Future of Aged Care

Trilogy Care is one of Australia’s fastest-growing approved Support at Home (HCP/S@H) providers.

We’re a vibrant, purpose-driven team dedicated to helping people live independently at home for longer. Our work goes beyond requirements - it’s about creating meaningful impact for our clients, their families, and our people. We’re proud to be building a workplace where individuals feel empowered, supported, and valued.

The Claims Integrity Team Lead is responsible for leading Trilogy Care’s claims quality function, overseeing a team of Claims Integrity Specialists to ensure accurate classification and compliant submission of all invoices to Services Australia. As the operational lead for claims integrity, this role is accountable for the accuracy and compliance of Trilogy Care’s claims under the Support at Home program, including the AT-HM scheme, and serves as a cross-functional partner for Finance, Quality Operations, and Digital teams.

What You’ll Do

• Team Leadership & Performance Management: Lead, coach, and develop a team of 4–6 Claims Integrity Specialists, setting clear performance expectations, allocating workloads, conducting 1:1s, performance reviews, and team meetings, and supporting professional growth.
• Claims Quality Assurance: Oversee accurate review and classification of invoices, ensuring alignment with the Support at Home service list, AT-HM scheme, and program rules; maintain team-wide accuracy through spot-checks, secondary reviews, and structured feedback.
• Subject Matter Expertise: Maintain deep working knowledge of Support at Home manuals, service lists, AT-HM guidelines, and Aged Care Rules 2025; serve as the primary escalation point and operational reference for classification queries.
• Process Improvement & Escalation: Identify process gaps, systemic errors, and supplier coding patterns; lead development and refinement of classification rules, decision frameworks, QA checklists, and team procedures; implement corrective actions and targeted training.
• Cross-functional Collaboration: Partner with Finance, Quality Operations, Data, and Digital teams to ensure claims data integrity, efficient processing, and resolution of systemic issues; communicate classification decisions with stakeholders, care partners, and suppliers.
• Continuous Improvement & Strategic Contribution: Drive root cause analysis of claim errors, translate findings into workflow improvements, updated guidance, and training; represent the team in meetings, QA reviews, and initiatives contributing to claims integrity strategy.

What You’ll Bring

Mandatory:

• Tertiary qualification in health, aged care, business, or related field; OR demonstrated equivalent experience in a regulated claims, compliance, QA, or operational leadership role.
• Demonstrated people leadership capability, including setting team expectations, providing performance feedback, and developing capability in others.
• Strong analytical skills and exceptional attention to detail; able to maintain accuracy standards and drive quality outcomes across high-volume invoice datasets.
• Excellent written and verbal communication skills; able to explain complex program rules clearly to diverse audiences and influence outcomes across teams and functions.
• Proficiency with digital systems, including portals, spreadsheets, data tools, and AI-assisted workflows; comfortable navigating multiple platforms in a team environment.
• Strong problem-solving and decision-making skills, able to manage competing priorities, resolve complex escalations under pressure, and maintain quality and compliance.
• Demonstrated knowledge of the Support at Home service list and AT-HM scheme, with ability to apply and teach this expertise across a team.

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.
• Previous exposure to aged care program rules, funding frameworks, or regulatory compliance, including the Aged Care Rules 2025 or Support at Home program.
• Experience leading a team within a QA, audit, compliance, or claims review function in health or government-funded services.

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.