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We are looking for a Senior Health Claims Expert – Individual Claims to join our Life &amp; Health Claims Division. In this role, you will lead initiatives to detect, prevent, and mitigate Fraud, Waste, and Abuse (FWA) across health insurance claims, combining deep operational expertise with advanced analytics. You will collaborate closely with data scientists, engineers, and compliance teams to design and implement solutions that strengthen claims integrity and minimize financial risk.What You Will Do:Claims Expertise &amp; Oversight<ul><li>Provide subject matter expertise on health claims processes, adjudication rules, and regulatory compliance.</li><li>Review and validate claim patterns, anomalies, and high‑risk indicators identified through analytics.</li></ul>Collaboration with Data Teams<ul><li>Partner with data analysts and engineers to define business requirements for FWA detection models.</li><li>Translate operational insights into data features used in predictive modeling and anomaly detection.</li><li>Validate model outputs and ensure alignment with business logic and balanced risk‑based decisions.</li></ul>Fraud Detection &amp; Prevention<ul><li>Support the development of advanced FWA strategies leveraging analytics, AI, and rule‑based systems.</li><li>Contribute to the creation of dashboards and reporting tools for monitoring suspicious claim behaviors.</li><li>Recommend corrective actions and process improvements based on analytical findings.</li></ul>Stakeholder Management<ul><li>Communicate complex analytical insights to non‑technical stakeholders in a clear and actionable manner.</li><li>Train claims teams (including TPA partners) on emerging fraud trends and data‑driven prevention techniques.</li></ul>What You Bring:Required<ul><li>8+ years of experience in health claims management, including at least 3 years in fraud detection.</li><li>Familiarity with analytics concepts (predictive modeling, anomaly detection).</li><li>Ability to work with SQL and dashboards (Power BI/Tableau), and understand data pipelines.</li><li>Strong understanding of the health insurance market, coding standards, and claims workflows.</li><li>Excellent analytical thinking, communication, and stakeholder engagement skills.</li></ul>Preferred<ul><li>Exposure to machine learning applications in healthcare.</li><li>Experience with FWA tools (e.g., SAS Fraud Framework).</li><li>Certification in fraud examination (CFE) or healthcare compliance.</li></ul>What We Offer:• Extensive training opportunities – on-demand and on-site • Partnerships with educational institutions across Greece for advanced study, with tuition support • Comprehensive Health Insurance for peace of mind and financial protection • Well-being support and work–life balance • One‑time budget for home-office equipment • Recognition and rewards for excellence • Monthly meal allowance • Newly renovated, centrally located offices with easy access

Senior Health Claims Expert (Individual Claims)

We are seeking an experienced Insurance Consultant to join our Insurance Services team, focusing on driving strategic change and operational excellence across insurance organizations. This role involves assessing and redesigning business processes, supporting senior decision-makers through data-driven insights, and collaborating closely with stakeholders to implement transformation initiatives that enhance efficiency, regulatory compliance, and customer value. The key responsibilities of this role will include:<ul><li>Participate in a broad range of business consulting projects in the insurance sector, mainly focusing on business and operational transformation</li><li>Support the gathering, structuring and documentation of functional and business requirements.</li><li>Understand and Analyze business documents such as policies, processes, procedures, and regulations.</li><li>Assist in or lead the creation of process maps, business workflows, and user journeys.</li><li>Collaborate with cross-functional teams including operations, developers, designers, testers, and other analysts.</li><li>Help ensure solutions align with business goals, user needs, and regulatory requirements.</li><li>Participate in or lead client meetings to clarify requirements and present findings.</li><li>Ensure professionalism, quality, and accuracy in all analysis outputs.</li><li>Contribute to a collaborative and ethical work environment.</li></ul>To be successful at this role you need the following (hard and soft skills):<ul><li>3+&nbsp;years of experience in the insurance sector in business consulting, analysis, project management or a similar role.</li><li>BSc/BA&nbsp;in Business, Insurance, Finance, or a related field.</li><li>Ability to understand and work with business documentation and translate it into functional/technical requirements in insurance industry.</li><li>Proven experience in designing business flows and functional specifications.</li><li>Strong interpersonal and communication skills.</li><li>Effective time management and organizational abilities.</li><li>Team-oriented mindset and collaborative working style.</li><li>High level of professionalism and work ethic.</li><li>Can work effectively both independently and as part of a team.</li><li>Have strong problem-solving skills and attention to detail.</li><li>Client-facing experience and ability to lead workshops or requirements sessions.</li></ul>What’s in it for You?At Grant Thornton Greece, we believe that great work deserves great rewards! Here’s what you can look forward to:<ul><li>🌈 Diverse and inclusive workplace</li><li>🏋️‍♂️ Friendly, Dynamic Working environment</li><li>💰 Competitive Salary &amp; Bonus</li><li>🩺 Insurance Program for all GT members</li><li>👩‍🏫 Fully funded Training &amp; Professional Qualifications</li><li>🏖 Extra Days-off: August Freedays, Volunteering Days</li><li>🏃🏽‍♂️ Corporate Sports Teams (e.g., Running, Basketball, Volleyball)</li><li>🎁 Exclusive Discounts: Special offers and discounts for employees</li><li>🚗 Company Car (depending on job level)</li></ul>

Insurance Business Consultant

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senior health claims expert (individual claims)

NN Hellas

insurance business consultant

Grant Thornton Greece

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