• Application Deadline:
• Position: HMO Claims Officer


• Job Type Full Time


• Qualification BA/BSc/HND


• Experience 3 - 5 years


• Location Lagos


• Job Field Medical / Healthcare 
  

Description 

• Examine bills and claims from using the agreed Tariff to ensure authenticity.


• Ensure bills are vetted before sending them to HMOs


• Ensure diagnosis matches with treatment


• Request for both payment advice and schedule from HMOs


• Ensure Authorization codes are received as appropriate for all secondary healthcare


• Ensure the lists of registered enrollees from HMOs are updated or ensure the enrollee's status is verified before treatment.


• Investigate suspicious claims through Enrollee contact, case folder checks and other approved protocols


• Escalate complicated fraudulent claims to the management.


• Forward approved Claims to Clinical Director for review and final approval.


• Participate in the resolution of medical claims cases requiring rigorous negotiations

Requirements

• Interested candidates should possess an HND with 3 - 5 years work experience.