Our client, a well-established insurance provider, is seeking an experienced Health Claims Specialist to join their growing team.

In this role, you will independently manage a diverse portfolio of health insurance claims—ranging from standard to moderately complex—ensuring accurate, fair, and prompt resolutions. You will serve as a key technical resource by interpreting medical data, mentoring junior associates, and optimizing workflows to deliver an exceptional customer experience.

Key Responsibilities

Oversee end-to-end processing for health claims; assess coverage, liability, and settlement values within authorized limits.
Analyze medical reports, treatment plans, and diagnostic codes to verify coverage validity against policy terms.
Support junior team members with policy interpretations, medical terminology, and difficult client interactions to streamline operations.
Spot potential fraud indicators, maintain audit-ready digital records, and ensure strict adherence to regulatory standards.
Liaise with policyholders, medical professionals, and brokers to resolve queries efficiently and maintain strong relationships.
Verify and process claim payouts, track financial data, and use claims software to improve operational efficiency.

Requirements

2–4 years’ experience in health insurance claims or a related insurance function
CII Diploma (or equivalent insurance qualification); medical background training is a sound asset
Sound knowledge of health policy terms, medical terminology, claims management software, and MS Office.
Competency in Microsoft Office and general data management software
Sharp attention to detail, strong organizational & multitasking skills, and willingness to learn
Leadership skills would be preferred
Full fluency in both English and Maltese is preferred

Benefits

Flexible hours
Summer hours
Health & Life insurance, as well as Voluntary Pension Scheme
New Mothers - can switch to reduced hours until child is 3years old
Continuous learning and Development programs and sponsorships
Quarterly team events

Health Claims Specialist

Job Description