JOB TITLE: Health Service / Quality Assurance Officer
JOB LOCATION: Abuja (FCT)
Employment Type: Full-time
Reports to: Head of Operations / Health Services
- 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.
- 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 of a Bachelor of Medicine and Bachelor of Surgery (MBBS).
- 4 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.
Note: Only successful candidates will be contacted.
|Job Category||Medical/ Healthcare / Pharmaceutical|