Medical Doctor - Health Claims & Medical Audit - Allianz - Agios Dimitrios

Job description

We are seeking a qualified Medical Doctor to join our Health Claims department. The role focuses on supporting claims adjudicators, auditing medical cases, and reviewing hospital invoices to ensure medical necessity, clinical appropriateness, and validity of charges in line with policy terms, provider contracts, and Greek healthcare standards.

Key Responsibilities:

Provide medical support to claims handlers on complex and high-cost cases
Review and audit medical claims for medical necessity, appropriateness, and coverage
Audit mainly inpatient cases (and rarely complex outpatient cases), including length of stay and treatment justification based on the relative medical protocols.
Review hospital invoices and verify charges against medical documentation, contracts, and KEN/DRG frameworks
Identify overbilling, unnecessary services, billing errors, and inconsistencies
Support cost containment and medical quality assurance initiatives
Communicate with providers and internal teams on medical and billing issues

Requirements:

Medical Degree (MD) and valid license to practice in Greece
Clinical experience (hospital experience preferred)
Good knowledge of the Greek healthcare system, private hospitals, and EOPYY environment
Experience in insurance, claims review, medical audit, or utilization review is a strong advantage
Strong analytical skills, attention to detail, and sound medical judgment
Good computer skills and professional communication abilities
AI literacy (Gen AI, Data Analysis, MS Copilot, ChatGPT

Preferred:

Experience in insurance, TPA, or healthcare audit
Postgraduate studies in Public Health, Health Management, or similar

We offer:

Health insurance
Pension plan
Performance-based bonus
Employee Share Purchase Plan
Free roadside assistance
Free appliance protection insurance
Travel‑insurance discount

Offers “Allianz”

Job description