Health Claims Adjuster - Provider Invoices Specialist (Direct Billing)

Job summary

We’re looking for a detail‑oriented and reliable provider invoice specialist to support our health claims operations, focusing on hospitalization cases. The role involves checking and validating provider invoices, applying contracted price lists, ensuring correct benefit application, and working closely with other departments to resolve discrepancies. You’ll contribute to accurate payments, smooth provider relations, and an efficient claims process.

Role

Invoice validation & processing

• review and validate provider invoices related to hospitalizations
• check alignment with contracted price lists, coverage rules, and approved services
• verify coding, quantities, dates, and medical documentation
• identify discrepancies or overcharges and follow up for clarification
• ensure timely and accurate processing of payable amounts

Price list checks & benefit application

• apply contracted price lists and reimbursement rules consistently
• confirm correct application of policy limits, exclusions, and cost‑sharing
• ensure that approvals and pre‑authorizations match invoiced services
• flag unusual charges or patterns to the team leader or provider relations

Communication & coordination

• liaise with hospitals, clinics, and providers to request clarifications or missing documents
• collaborate with claims adjusters, medical team, and provider relations on complex files
• coordinate with finance for payment processing and invoice flow
• respond to internal queries regarding pricing, approvals, or invoice status

Quality, compliance & documentation

• maintain complete and accurate documentation for each invoice reviewed
• follow internal procedures, audit requirements, and client‑specific guidelines
• ensure data accuracy and proper recording of all actions in the system
• support quality initiatives by applying consistent and compliant handling

Process support & continuous improvement

• identify recurring issues in provider billing or internal workflows
• suggest improvements to enhance efficiency and accuracy
• participate in system updates, new workflows, and periodic trainings
• support implementation of changes coming from clients or internal teams

Requirements

Qualifications & experience

• university degree in insurance, finance, business administration, healthcare management, or a related field
• 1–3 years of experience in health claims, medical billing, or provider invoice validation
• understanding of hospitalization workflows, medical pricing, and reimbursement rules
• familiarity with greek healthcare providers and price list structures is an advantage

Skills & competencies

• strong attention to detail and numerical accuracy
• ability to analyze invoices and detect inconsistencies
• organized and able to manage multiple cases and deadlines
• clear communication skills for liaising with providers and internal teams
• fluency in greek and good command of english
• comfortable using MS office and claims/invoice management systems
• openness to using AI‑enabled tools to support daily tasks:  Generative Artificial Intelligence or GenAI or AI, Data Analysis, (Microsoft) Copilot, ChatGPT

Preferred (optional)

• experience in a TPA environment
• knowledge of greek private hospital pricing structures
• previous involvement in audits or quality reviews
• experience handling hospitalization cases or DRG‑related billing

91505 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

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