Outpatient Benefits Specialist

• 14 octobre 2026
• 100%
• Indefinite duration
• Winterthur

Join our team as Fachspezialist*in Leistungen ambulant in Winterthur. This opportunity offers a flexible home office environment.

Tasks ##

• Processing of complex outpatient benefit cases (KVG/VVG).
• Evaluation of reimbursement requests according to legal and internal standards.
• Communication of decisions to insured persons and service providers.

Skills ##

• Medical or commercial training with a specialization in social insurance.
• Skills in benefit validation and affinity for law.
• Excellent communication and analytical skills.

Outpatient Benefits Specialist

60 %, Winterthour, Home office

What awaits you

• Processing of complex outpatient benefit files (KVG/VVG)
• Examination and processing of outpatient coverage taking into account legal, tariff, and internal regulations
• Processing of requests via email, telephone calls, and written correspondence
• Independent technical insurance clarifications in collaboration with the medical advisor
• Communication of benefit decisions to insured persons and providers as well as professional support and advice to providers, internal departments, agencies, and policyholders
• Integration and professional support of new employees
• Participation in the design and optimization of processes and regulations with a focus on quality, efficiency, and digitalization

What you bring

• Basic medical or commercial training
• Continuing education in the field of social insurance
• Experience in a comparable function, ideally in the field of health insurance
• Very good knowledge in benefit control and strong affinity for legal issues
• Committed, autonomous, and stress-resistant personality
• Excellent communication and negotiation skills
• Analytical skills as well as a structured and solution-oriented working method
• Perfect mastery of German orally and in writing, other languages are an asset