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
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 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 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