Health Service / Quality Assurance Officer
Markfema Nigeria Limited
Abuja, NG
23h ago
source : Mrjobsnaija

Markfema Nigeria Limited's job vacancy, Career and Recruitment

Job title : Health Service / Quality Assurance Officer jobs in Abuja Job Location : Abuja Deadline : January 18, 2022

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  • 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 Ûª Claims using the Tariff agreement to determine authenticity and payment.
  • Decline fraudulent Healthcare Providers Ûª 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 Ûªs office using the checklist.
  • Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
  • Update Providers Ûª 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 Ûªs benefits.
  • Ability to make a professional judgment on coverage and non-coverage of care requests per time, based on the enrollee Ûªs benefits table.
  • Candidate must have strong computer skills.
  • Medical / Healthcare jobs in Nigeria *Medical / Healthcare jobs in Abuja *Health Service / Quality Assurance Officer in Abuja
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