• Application Deadline:
• Position: Claims Examiner


• Job Type Full Time


• Qualification BA/BSc/HND


• Experience


• Location Lagos


• Job Field Medical / Healthcare 
  

JOB SUMMARY

This role is 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.

JOB DESCRIPTION

• Examine Healthcare Providers’ Claims using Tariff agreement to determine authenticity & payment.


• Forward approved Claims to Team Lead for review and final approval.


• Investigate complicated Claims and escalate to Team lead, if necessary.


• Investigate complicated claims by speaking to Enrollees and providers.


• Update Providers’ dashboard and implement resolutions.


• Decline fraudulent Healthcare Providers’ Claims and state causative reasons.


• Escalate fraudulent cases to the Team lead.


• Relate with the Customer Success team to manage concession requests.


• Relate with technology team on any update on the processes regarding the claims of Providers.


• Relate with Provider Relations Service unit for tariff agreement.
  
   

JOB EXPERIENCE

• Minimum of a first degree in Medicine or nursing


• Previous experience in a claim examiner role is a major advantage.


• Excellent numeracy, analytical and problem-solving skills.


• Strong medical and clinical knowledge and experience


• Excellent interpersonal and communication skills.