Job Description
Posted 18/03/2026
Job Number 60300
Work type Permanent - Full Time
Posting End Date 15/04/2026
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.
Job Number 60300
Work type Permanent - Full Time
Posting End Date 15/04/2026
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.
💡 Quick Summary
Seeking a career-building opportunity? The Clinical Team Leader position is now open for candidates interested in the BPO Jobs sector. This role in Adelaide offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in BPO Jobs is a plus.