Administration Specialist

Job Description

The Administration Specialist will be responsible for optimising administrative processes within a healthcare and insurance operations environment. The successful candidate will balance operational efficiency, financial stewardship, and exceptional service delivery, while ensuring compliance with regulatory and company standards. Key Responsibilities: Oversee and optimise administrative processes related to medical claims and healthcare operations. Ensure compliance with internal policies, regulatory requirements, and data protection standards. Coordinate with assistance, claims, medical, and provider network teams to ensure smooth operations. Process vendor invoices and payments through SAP. Perform payment runs accurately and within established deadlines. Prepare reports, collect and analyse data, and provide administrative support to management. Maintain accurate digital and paper-based records, files, and archives. Contribute to the development and maintenance of process documentation and operational manuals. Support the implementation of cost containment strategies aimed at reducing claim costs while maintaining quality of care. Monitor billing practices and identify discrepancies, duplicate charges, or non-covered services. Collaborate with provider networks to support cost-effective healthcare solutions. Assist in reviewing high-cost treatments and healthcare utilisation trends. Support initiatives focused on healthcare cost optimisation and resource management. Assist in monitoring and coordinating case management activities. Support the identification and management of complex or high-cost cases. Help ensure effective care coordination and positive customer outcomes. Promote efficient and cost-effective care pathways where appropriate. Analyse operational and claims data to identify trends and improvement opportunities. Monitor key performance indicators (KPIs) and prepare management reports. Support data-driven decision-making through accurate reporting and analysis. Assist with fraud, waste, and abuse detection through audits and data reviews. Ensure adherence to company procedures, healthcare regulations, and data protection requirements. Maintain accurate documentation to support regulatory and legal compliance. Support internal audits and continuous improvement initiatives. Requirements: Degree in Healthcare Administration, Business Administration, Nursing, or a related field. Previous experience within insurance, healthcare administration, medical claims, TPA services, or a similar environment. Familiarity with healthcare cost containment practices and case management principles. Experience with SAP or similar ERP/financial systems preferred. Strong analytical skills with the ability to interpret complex data sets. Excellent organisational skills and attention to detail. Strong written and verbal communication skills. Proficiency in Microsoft Office Suite (Excel, Word, Outlook). Ability to work independently and collaboratively in a team environment. High level of discretion and ability to handle sensitive/confidential information. Outreach Recruitment Agency

More Info

Education