health medical quality

As a Health Medical Quality employee, you will oversee and coordinate health claims processes, ensuring accuracy, compliance, and efficiency through data analysis, quality control, provider management, and collaboration with internal teams and the Third Party Administrator.

Your day-to-day:

• Daily movement analysis report and coordination of necessary actions with Third Party Administrator

• MTD/YTD claims result analysis in cooperation with reporting specialist and deep dive in focus areas

• Monthly reserve review of claims to ensure correctness of financial representation according to policy terms

• Assess the quality control results in health portfolio claims processes based on insurance terms / business rules / providers contracts and process coordination with Third Party Administrator (sampling, framework, arbitration, measurements)

• Coordinate regular management meetings with Third Party Administrator and safeguard insurance management guidelines for claims handling

• Active participation in all projects related to claims area as subject matter expert

•  Ad hoc presence in Arbitration Committees with hospitals 

• Support contract amendments and agreements with providers and benchmark exercises on expense level

• Ad hoc analysis, upon respective requests, of claims areas by downloading data, analyse them and perform qualitative checks (expense, insurance guidelines, expense coding, contractual terms)

• Act as liaison between IT, Operations and Third Party Administrator for related day-to-day issues (claim registers, suspense accounts reconciliation, bugs / errors on interfaces

Qualifications:

• At least 6 years of experience of claims handling of health portfolio and experience in the insurance industry with sufficient knowledge of insurance process value chain

• University degree

• Oral and written skills in English

Personal Profile:

• Interested in insurance products and knowledge of the Greek market

• Easily and passionately analyse complex processes

• Organizational skills

• Excellent communication skills and deal with other people

• Team spirit

What we offer:

• Extensive training opportunities - on-demand and on-site options, webinars, seminars, and fully covered certifications.

• Partnership with multiple educational institutions across Greece for advanced education, with tuition support.

• Comprehensive Health Insurance that keeps you safe, with peace of mind and financial protection in times of need.

• Pension Scheme to secure your financial future and ensure you can plan confidently for the years ahead.

• Well-being and work-life balance, including extra days off for medical emergencies, no medical note needed, and support for working parents.

• One-time budget for home-office equipment to make your work-from-home comfortable.

• Recognition and rewards for excellence, including bonuses and salary increases based on your contribution throughout the year.

• Monthly meal allowance that can be used at supermarkets and cafeterias, including our own offices' cafeteria.

• Recently renovated offices, central location, with easy access