Health Services / Quality Assurance Officer in a Leading HMO in Abuja


  2020-05-26
  Unspecified

A leading Health Maintenance Organisation (HMO) and a major player in the Nigeria Health Insurance Industry with Head Office in Abuja and offices spread across the country.

Due to steady growth and expansion, we seek competent, experienced and dedicated individuals to fill the following vacant positions below:

Job Title: Health Services / Quality Assurance Officer

Location: Abuja
Employment type: Full Time
Reports to: Head of Operations/Health Services

Job Description

  • Shall be ready to work hard and push the limits in ensuring claims vetting and fluent management process.
  • shall be responsible for vetting all claims submitted by our Providers to ensure they are error and fraud free
  • They will manage claims payment and be involved in the resolution of medical cases requiring special attention.

Minimum Qualifications

  • Minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS).
  • Additional qualification and relevant work experience in a similar role is an added advantage
  • Excellent Numeracy, Analytical and Problem-solving skills.
  • Strong ability to make judgments on medical/ surgical cases in relation to benefits listed on enrollee’s benefits.
  • Ability to make professional judgment on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.
  • Candidate must have strong computer skills.

Key Responsibilities

  • Examine Healthcare Providers’ Claims using the Tariff agreement to determine authenticity and payment.
  • Decline in fraudulent Healthcare Providers’ Claims and state causative reasons.
  • Forward approved Claims to Team Lead for review and final approval.
  • Investigate complicated Claims and escalate to Team lead, if necessary.
  • Carry out a physical inspection at the assigned provider’s office using the checklist.
  • Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
  • Update Providers’ dashboard, and implement resolutions.

Salary

  • Very competitive and based on experience.

Deadline: 8th June, 2020.

How to Apply
Interested and qualified candidates should send their CV and Cover Letter to: dgl.info@yandex.com clearly indicating the “Job Title” as subject of your mail.

Note: Only successful candidates will be contacted.

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