Claims Adjuster - Health Individual claims

Job description

We’re looking for a detail‑driven and service‑minded claims adjuster to join our health claims team for individual policies. In this role, you’re responsible for reviewing and assessing medical claims, applying policy benefits correctly, communicating with customers and providers, and making sure each claim is handled accurately and on time. You’ll play an important part in delivering a smooth, fair, and supportive claims experience for our members, while working closely with the rest of the team and following our operational and client guidelines.

Job Role

Claims processing & case handling

• review, assess, and adjudicate health insurance claims for individual policies

• check eligibility, coverage, benefits, limits, exclusions, and required documents

• make clear, well‑reasoned benefit decisions based on policies and procedures

• ensure every claim is processed within agreed SLAs

• request missing information from members or providers when needed

• escalate complex or unclear cases to the team leader or medical team

Quality, compliance & documentation

• maintain accurate and complete claim files in the system

• ensure every action is properly documented for audit purposes

• follow operational procedures, client-specific guidelines, and internal controls

• apply benefits consistently and fairly to help maintain high quality standards

Communication & coordination

• communicate with members, hospitals, doctors, and partners to clarify details or obtain extra documentation

• provide clear updates on claim status, requirements, or outcomes

• collaborate with the medical team for cases requiring medical review

• support provider relations by reporting unusual charging patterns or recurring issues

Customer service & issue resolution

• provide friendly, clear, and supportive communication throughout the claim journey

• help members understand reimbursement decisions, required documents, or next steps

• handle routine complaints or questions professionally and with empathy

Process support & continuous improvement

• share observations on recurring issues or process gaps

• participate in trainings, system updates, or new workflow rollouts

• contribute ideas on how to improve customer experience and operational efficiency

Qualifications & experience

• university degree in insurance, finance, business, healthcare management, or a similar field

• 1–3 years of experience in health claims handling (TPA or insurer) is preferred

• understanding of health insurance products, basic medical terminology, and claims workflows

• familiarity with the greek healthcare landscape is a nice advantage

Skills & competencies

• strong analytical thinking and attention to detail

• good judgement and ability to make benefit decisions confidently

• organized, reliable, and able to manage several cases at once

• customer‑focused mindset and clear communication style

• fluency in greek and good command of english

• comfortable using MS office and claims management systems

• openness to using AI‑enabled tools and data insights ( Artificial Intelligence or GenAI or AI, Data Analysis, Microsoft Copilot, ChatGPT)

Preferred (optional)

• experience in a TPA environment

• previous exposure to individual (retail) health insurance policies

• experience in customer service, healthcare administration, or medical billing

• participation in quality reviews or audits

91557 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. 

At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. And the foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion and trust. 

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations. 

Great to have you on board. Let's care for tomorrow.