On behalf of our client, a reputable Insurance company based in Malta, GRS Recruitment is seeking a dedicated a Healthcare Administration Specialist. The ideal candidate will be a results-driven 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. Combine financial stewardship with strong member advocacy, ensuring efficient, compliant, and data-drive decision-making across the organization. If you feel you have the necessary skills, please apply for this Malta based roe.
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.
- 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.
- Perform any related tasks as requested by Management and necessary for the upkeep of the company’s services, assets, or premises in outmost confidence.
- 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
- Case management and care coordination
- Utilization management (UM)
- Medical claims analysis and billing controls
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
Due to the high volume of applications, we receive at GRS Recruitment, only shortlisted candidates will be responded to.
