Head, Claims Management Unit in a Leading NHIS Accredited National Health Maintenance Organization


  2020-11-12
  Unspecified

A reputable dynamic and leading NHIS Accredited National Health Maintenance Organization is looking to recruit suitable candidates to fill the position below:

Job Title: Head, Claims Management Unit

Location: Abuja

Background

  • The Head of Claims Unit will oversee the handling of all claims in line with the approved NHIS Drug and Service tariffs for payment to secondary/tertiary healthcare providers that render services on referrals from other accredited healthcare providers.
  • These functions are performed under the immediate supervision of the Head, Medical & Quality Assurance Department and would also be required to serve in acting capacity when the Head of Medical Department is not available.

Qualifications
Education:

  • Registered Professional Nurse and first-level degree from an accredited Baccalaureate Nursing Programme (University) or equivalent.
  • National registration and licensing are required.
  • Recognized additional training in primary health care and midwifery is desirable;

Experience:

  • Minimum 3 years of continuous Claims Management experience;
  • Experience in the usage of computers and other relevant software packages is desirable.

Language Requirements:

  • Fluency in oral and written English is a requirement.

Competencies:
Professionalism:

  • Knowledge and experience in Claims Management.

Communication:

  • Ability to write in a clear and concise manner and to communicate effectively orally.

Teamwork:

  • Good interpersonal skills; ability to work in a multi-cultural, multi-ethnic environment with sensitivity and respect for diversity.
  • Establishes, build and sustain effective relationships within the work unit.

Planning and Organizing:

  • Develops clear goals that are consistent with agreed strategies;
  • Ability to establish priorities and to plan and co-ordinate own work plan;
  • Allocates appropriate amount of time and resources for completing work;
  • Foresees risks and allows for contingencies when planning;
  • Monitors and adjusts plans and actions as necessary; uses time efficiently.
  • Organizes and prioritizes work schedule to meet deadlines.

Technological Awareness:

  • Proficiency in relevant medical software packages.

Commitment to Continuous Learning:

  • Initiative and willingness to keep abreast of new skills in the field.

Duties And Responsibilities

  • Coordinate and supervise the activities of the Unit to ensure optimal performance;
  • Coordinate and handle the collation, entry and analysis/reporting of encounter returns from hospitals
  • Analyze data for bill presentation based on requirements and review claims for quality and elimination of fraud
  • Maintains supplies inventory for our train operations by checking stock to determine inventory level; anticipating needed supplies; placing and expediting orders for supplies; verifying receipt of supplies; using equipment and supplies as needed to accomplish results
  • Maintains a cooperative relationship among team members by communicating information, responding to requests, building rapport and participating in team problem-solving methods
  • Coordinate and oversee maintaining of records as it relates to all the activities in the Unit.
  • Stays up to date on regulations, and implements changes regarding claims and billing requirements
  • Ensures quality health care delivery to enrollees by continuous monitoring and evaluation of healthcare facilities.
  • All other duties that might be assigned by reason of the position.

Deadline: 26th November, 2020.

Method of Application
Interested and qualified candidates should send their Application and CV to: ourrecruitment@gmail.com using the “Job Title” as the subject of the email.

Note: Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

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