About Doctors Health Fund Doctors’ Health Fund is a restricted private health insurer dedicated exclusively to the medical community and their families. Proudly part of the Avant Mutual Group, we’re owned by doctors, not shareholders, and support more than 50,000 members across Australia.We’re focused on providing quality health cover, exceptional member service and genuine support to Australia’s medical community. About the Role We’re looking for an experienced Senior Complaints Manager to manage major, complex and high-risk complaints for Doctors’ Health Fund.
This is a senior specialist role with particular responsibility for complaints referred or escalated to the Private Health Insurance Ombudsman (PHIO). You’ll lead matters from investigation through to resolution, working with members, internal stakeholders and external bodies to achieve fair, timely and well-supported outcomes. Beyond individual cases, you’ll use complaint insights to identify systemic issues, strengthen processes and support leaders across DHF with complex complaint management.
This is a permanent part-time position, with the working pattern structured to provide appropriate coverage for urgent and time-sensitive matters. Key Responsibilities Manage major, complex, sensitive and high-risk complaints from investigation through to resolution Act as the key operational contact for PHIO complaints and enquiries, coordinating responses, evidence and required actions Conduct impartial investigations and provide clear, well-reasoned complaint outcomes Assess member impact and recommend fair and appropriate remedies Identify and escalate potential regulatory, privacy, legal, systemic or member risks Maintain accurate and audit-ready complaint records and documentation Identify complaint trends, root causes and opportunities for systemic improvement Prepare complaint insights, briefings and reporting for senior leaders, Risk and Compliance and relevant committees Provide specialist guidance and quality review for leaders managing escalated complaints Partner across DHF and Avant to resolve complex matters and improve the overall member experience Key Capabilities You’ll be an experienced complaints professional with strong judgement and the confidence to manage sensitive, complex and externally escalated matters.
You’ll ideally bring: Significant experience managing complex or high-risk complaints within private health insurance, insurance, financial services, healthcare or another regulated environment Experience responding to an ombudsman, regulator or external dispute resolution body, with PHIO experience highly regarded Strong investigation, evidence assessment, root cause analysis and case management skills Excellent written communication skills across complaint outcomes, regulatory responses and senior-level briefings Strong de-escalation, negotiation and conflict-resolution skills Sound knowledge of complaint handling, procedural fairness, privacy, remediation and risk escalation requirements The ability to identify systemic issues and translate findings into practical improvements Strong stakeholder management skills, including confidence working with senior leaders and external bodies Excellent judgement, discretion, organisation and attention to detail A relevant tertiary qualification and/or formal training in dispute resolution, investigations or complaint handling Knowledge of the Australian private health insurance environment, PHIO pathways and the Private Health Insurance Code of Conduct is highly regarded
Job description provided by Avant Mutual.
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