On behalf of our client, an Travel Insurance Firm in Malta, GRS Recruitment are seeking an Medical Claims Administration Specialist with expertise in medical claims, cost containment and case management. Responsible for overseeing administrative back operations while implementing strategies that control healthcare costs, optimize resource utilization, and ensure high-quality patient outcomes. Combines financial stewardship with strong member advocacy, ensuring efficient, compliant, and data-driven decision-making across the organization.

MAIN DUTIES AND RESPONSIBILITIES

Oversee and optimize administrative processes related to medical claims and healthcare operations
Ensure compliance with internal policies, regulatory requirements, and data protection standards
Manage budgets, reporting, and operational performance indicators
Coordinate cross-functional teams including assistance/claims, medical, and provider network units
Accounting for vendor invoices and payments using SAP accounting system
Performing payment runs timely
To analytically perform any administrative, support, data collection and data inputting with care and accuracy as necessary to provide the Client or Management with the services required
To perform any related tasks as requested by Management and necessary for the upkeep of the company’s services, assets, or premises in outmost confidence
To upgrade and maintain in meticulous order both paper based and digital files, folders, and archives
Contribute towards our process notes and manuals
Design and implement cost containment programs focused on reducing medical claim expenses without compromising care quality
Apply utilization management techniques such as preauthorization, concurrent review, and retrospective review
Monitor billing practices, coding accuracy, and apply medical bill review controls (e.g., detection of upcoding, duplication, or non-covered services)
Collaborate with provider networks to negotiate pricing, promote in-network usage, and guide cases toward high-value care settings
Support pharmacy cost optimization through formulary control, prior authorizations, and review of high-cost treatments
Lead end-to-end case management processes from identification to closure
Ensure early identification of high-cost, complex, or catastrophic cases
Supervise and train case handlers (clinical or non-clinical), ensuring effective care coordination and patient advocacy
Oversee care planning, monitoring, and intervention strategies to achieve optimal clinical and financial outcomes
Promote alternatives to high-cost care (e.g., outpatient treatment, home care, rehabilitation programs)
Utilize analytics to identify cost drivers, trends, and improvement opportunities
Define and monitor key performance indicators (KPIs), including:
Medical cost per claim
Savings per managed case
Length of stay (LOS)
Readmission rates
Case duration and closure effectiveness
Produce dashboards and reports for executive decision-making
Ensure medical necessity and evidence-based decision-making across all processes
Establish clear escalation paths and audit frameworks
Maintain proper documentation for regulatory and legal compliance
Support fraud, waste, and abuse (FWA) detection through data analysis and audits

CANDIDATE PROFILE

Degree in Healthcare Administration, Business Administration, Nursing, or related field
Experience in insurance, TPA, corporate healthcare benefits, or medical claims management
Proven track record in cost containment and case management programs
Familiarity with healthcare systems, coding standards (ICD/CPT), and utilization review processes
Strong analytical and strategic mindset with a focus on measurable results
Able to communicate verbally and in written form in both Maltese and English
Ability to balance cost efficiency with quality of care and patient outcomes
Excellent leadership and cross-functional coordination skills
Proactive approach to problem-solving and continuous improvement
High level of integrity, compliance awareness, and attention to detail
Cost containment & healthcare financial management
High attention to detail
Strong organizational and multitasking abilities
Be able to work independently and manage task continuity

SALARY AND BENEFITS

€40,000 - €50,000 Gross Per Annum
Salary will be determined based on experience, qualifications, and skills. The advertised salary range is indicative, any offer will reflect the successful candidate’s suitability
Office based or hybrid role; limited or no patient contact
Flexible on call availability for complex or high risk cases
Collaboration across multiple time zones
Strategic medical role with global exposure
Opportunity to influence medical standards and patient outcomes internationally
Professional development in medical governance and insurance medicine

Due to the high volume of applications, we receive at GRS Recruitment, only shortlisted candidates will be responded to.

To apply for this position, please email your CV to Michelle Cooper, quoting the above job reference or call +356 99998272.

Salary: €40,000-50,000 per year

Medical Claims Administration Specialist

Job Description