Claims Representative (GEH) - Provider Service Organisation

Role Overview

Process international medical, dental and vision claims, applying the relevant policy terms while keeping decisions accurate and on schedule. You’ll also help providers and colleagues resolve claim and coverage questions, flag cases that need attention, and contribute to the smooth delivery of claims services across European operations.

Key Responsibilities

• Assess and adjudicate medical, dental and vision claims against policy conditions and service-quality standards.
• Track high-value claims and alert the appropriate colleagues when a case requires further review or action.
• Manage assigned claims to meet turnaround targets, escalating promptly when deadlines may be missed.
• Respond to enquiries about plan design, member eligibility and claim progress, taking appropriate action and resolving issues at first contact where possible.
• Work with healthcare providers and internal teams to investigate and resolve service or payment concerns.
• Take responsibility for the providers in your allocated country cluster and maintain effective working relationships with them.
• Suggest practical improvements to claims processes and share recommendations with senior team members.
• Support colleagues and take on additional claims or administrative tasks as business priorities require, including work across European operations.

Requirements & Qualifications

• At least one year of experience in medical administration, claims handling or an accounting environment.
• Strong attention to detail and accuracy when reviewing information and entering or processing data.
• Confident written and verbal communication skills for working with both internal colleagues and external providers.
• A customer-focused approach, with the ability to investigate problems and identify suitable solutions.
• Ability to organize and prioritize a varied workload, manage competing tasks and contribute to individual and team targets.
• Sound judgement, initiative and a willingness to recommend process improvements.
• Proficiency with Microsoft Office applications.
• English and arithmetic qualifications are preferred.