Our client is looking to onboard an Administration Specialist with extensive expertise in medical claims, cost containment, and case management. Responsible for driving operational excellence through effective administration, cost-control initiatives, and resource optimisation, while maintaining high standards of patient care and service delivery. Balances financial stewardship with strong member advocacy to ensure sustainable, compliant, and data-driven outcomes across the organization.
Responsibilities
- Oversee and optimise administrative processes supporting medical claims and healthcare operations
- Ensure compliance with internal policies, regulatory requirements, and data protection standards
- Manage operational budgets, reporting, and performance metrics
- Coordinate activities across Claims, Assistance, Medical, and Provider Network teams
- Oversee vendor invoice processing, payment runs, and financial administration through SAP
- Maintain accurate records, documentation, and operational procedures
- Develop and implement cost-containment initiatives to reduce medical claim expenses while maintaining quality of care
- Review billing and coding practices to identify errors, duplication, non-covered services, and cost-saving opportunities
- Collaborate with providers to negotiate costs, promote in-network utilisation, and direct cases to cost-effective care settings
- Support pharmacy cost-management initiatives, including prior authorisations and review of high-cost treatments
- Lead end-to-end case management processes, ensuring timely identification and management of complex and high-cost cases
- Supervise case management staff and promote effective care coordination and patient advocacy
- Oversee care plans and intervention strategies to achieve optimal clinical and financial outcomes
- Analyse claims and operational data to identify trends, cost drivers, and improvement opportunities
- Monitor and report on key performance indicators, including medical cost per claim, savings achieved, length of stay, readmission rates, and case outcomes
- Prepare management reports and dashboards to support decision-making
- Ensure decisions are aligned with medical necessity criteria and evidence-based practices
- Ensure regulatory, legal, and contractual compliance through accurate documentation and oversight
- Support fraud, waste, and abuse prevention through monitoring, audits, and data analysis
Requirements
- Degree in Healthcare Administration, Business Administration, Nursing, or a related field
- Proven experience within insurance, third-party administration (TPA), corporate healthcare benefits, or medical claims management
- Demonstrated experience in cost containment and case management programmes
- Sound knowledge of healthcare systems, utilisation management processes, and medical coding standards (ICD/CPT)
- Strong analytical and strategic thinking with a results-driven approach
- Ability to balance cost efficiency with quality care and positive patient outcomes
- Excellent leadership, stakeholder management, and cross-functional collaboration skills
- Strong communication skills, both verbal and written, in Maltese and English
- High level of integrity, compliance awareness, and attention to detail
Benefits
- Flexible Working Hours
- Hybrid
- Health Insurance
- Performance Bonus
- Company Discounts
Kindly note that some vacancies are only considering Maltese or EU nationals in line with Jobsplus requirements. More information can be found here.
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