• Application Deadline: Tue, 18 Jan 2022 00:00:00 GMT
• Position: Health Service / Quality Assurance Officer


• Job Type Full Time


• Qualification BA/BSc/HND


• Experience 3 years


• Location Abuja , Lagos , Rivers


• Job Field Medical / Healthcare 
  

Reports to: Head of Operations / Health Services

The Candidate

• 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.

Key Responsibilities

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


• Decline 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 the 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.

Minimum Qualifications

• Minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS).


• 3 years work experience.


• Additional post-graduate qualifications will be an advantage


• Previous relevant work experience in a similar role will be 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 a 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.