SME – Claims Management (incl. Workload Balancing & TPA Interface)] (m/f/d)

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Start: 01.01.2026 | Remote: 100%

Beschreibung

We are one of the leading international recruitment agencies for the procurement of highly qualified experts in fields such as IT lifecycle management, SAP, engineering, commerce and specialist consultancy.

Please note that we can only present candidates to this client who have a contractual relationship with a company and are subject to social security contributions. Managing partners are classified as freelancers according to the definition there and can therefore not be considered.

For our client we are currently looking for a


SME – Claims Management (incl. Workload Balancing & TPA Interface)] (m/f/d)

General information
Reference: 176622
Location: Munich and Remote
Start: 01.01.2026 (ASAP)
Volume: full-time (100%)
Duration: 30.06.2026 + Option
Languages: German, English

Your Skills
- 4-5 years in health claims operations (retail/group), with process re-engineering experience.
- Experience working with TPAs and API data exchanges in India.
- Familiar with claims systems (e.g., MediAssist, Raksha, Core IT platforms).
- Strong analytical and problem-solving skills for system testing and exception handling.
- Proven ability to translate business process logic into system requirements.
- Skilled in “as-is” and “to-be” mapping, gap analysis, and workflow design.
- Experience working with IT development and QA teams on core insurance systems
- Excellent documentation, analytical, and stakeholder management skills.

Your Tasks
- Map end-to-end claims process: intimation → adjudication → approval → payment.
- Define workload balancing logic and queue management rules for claims teams.
- Design data and process interfaces with TPAs (EDI/API structures).
- Define claim status taxonomy, turnaround times, and escalation hierarchies.
- Support configuration of fraud triggers and quality checks.
- Ensure regulatory compliance for cashless and reimbursement claim processing.

Interested?
We look forward to receiving your application documents in electronic form.