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Health Service / Quality Assurance Officer at Markfema


Full Time
Posted 2 weeks ago

Markfema Nigeria Limited is one of the 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.

Health Service / Quality Assurance Officer at Markfema 1

JOB TITLE: Health Service / Quality Assurance Officer

JOB LOCATIONAbuja (FCT)
Employment Type: Full-time
Reports to: Head of Operations / Health Services

JOB DETAILS:

  • 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).
  • 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.

Apply Now

Note: Only successful candidates will be contacted.

Deadline: Tomorrow

Job Features

Job CategoryMedical/ Healthcare / Pharmaceutical
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