NN Group

Senior Health Claims Expert (Individual Claims)

NN Group  •  Hellenic Republic (Onsite)  •  3 months ago
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Job Description

About Us:

At NN Hellas, we're proud to be the #1 insurance company in Greece, offering innovative insurance solutions that serve the entire country since the 1980s.
We have a proven track record of taking exceptional care of our people — we have been recognized as a Top Employer for 8 consecutive years, reflecting our commitment to an inclusive, supportive, and growth‑oriented workplace.

What you will do:

We are looking for a Senior Health Claims Expert – Individual Claims to join our Life & Health Claims Division.
In this role, you will lead initiatives to detect, prevent, and mitigate Fraud, Waste, and Abuse (FWA) across health insurance claims, combining deep operational expertise with advanced analytics. You will collaborate closely with data scientists, engineers, and compliance teams to design and implement solutions that strengthen claims integrity and minimize financial risk.

What You Will Do:

Claims Expertise & Oversight

  • Provide subject matter expertise on health claims processes, adjudication rules, and regulatory compliance.

  • Review and validate claim patterns, anomalies, and high‑risk indicators identified through analytics.

Collaboration with Data Teams

  • Partner with data analysts and engineers to define business requirements for FWA detection models.

  • Translate operational insights into data features used in predictive modeling and anomaly detection.

  • Validate model outputs and ensure alignment with business logic and balanced risk‑based decisions.

Fraud Detection & Prevention

  • Support the development of advanced FWA strategies leveraging analytics, AI, and rule‑based systems.

  • Contribute to the creation of dashboards and reporting tools for monitoring suspicious claim behaviors.

  • Recommend corrective actions and process improvements based on analytical findings.

Stakeholder Management

  • Communicate complex analytical insights to non‑technical stakeholders in a clear and actionable manner.

  • Train claims teams (including TPA partners) on emerging fraud trends and data‑driven prevention techniques.

What You Bring:

Required

  • 8+ years of experience in health claims management, including at least 3 years in fraud detection.

  • Familiarity with analytics concepts (predictive modeling, anomaly detection).

  • Ability to work with SQL and dashboards (Power BI/Tableau), and understand data pipelines.

  • Strong understanding of the health insurance market, coding standards, and claims workflows.

  • Excellent analytical thinking, communication, and stakeholder engagement skills.

Preferred

  • Exposure to machine learning applications in healthcare.

  • Experience with FWA tools (e.g., SAS Fraud Framework).

  • Certification in fraud examination (CFE) or healthcare compliance.

What We Offer:

• Extensive training opportunities – on-demand and on-site
• Partnerships with educational institutions across Greece for advanced study, with tuition support
• Comprehensive Health Insurance for peace of mind and financial protection
• Well-being support and work–life balance
• One‑time budget for home-office equipment
• Recognition and rewards for excellence
• Monthly meal allowance
• Newly renovated, centrally located offices with easy access

NN Group

About NN Group

NN Group is an international financial services company, active in 10 countries, with a strong presence in a number of European countries and Japan. We are rooted in the Netherlands and have a rich history spanning 180 years.

With our 16,000 colleagues, NN Group provides retirement services, pensions, insurance, banking and investments to approximately 19 million customers. NN Group includes Nationale-Nederlanden, NN, ABN AMRO Insurance, Movir, AZL, BeFrank, OHRA and Woonnu.

NN Group opened for trading on 2 July 2014 on Euronext Amsterdam under the symbol ‘NN’ after its initial public offering (IPO).

Throughout our history, we have merged, grown and changed, but the core of who we are has remained the same. At NN Group, we put our resources, expertise, and networks to use for the well-being of our customers, the advancement of our communities, the preservation of our planet, and for the promotion of a stable, inclusive, and sustainable economy.

Our purpose is to help people care for what matters most to them. Because what matters to them matters to us.

Industry
Finance & Insurance
Company Size
10,000+ employees
Headquarters
Den Haag, NL
Year Founded
Unknown
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