Administration Specialist (Hybrid)

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