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

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Administration Specialist (Hybrid)

Job Description