Medical Doctor - Health Claims & Medical Audit

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 inco...