Senior Claims Associate at RelianceHMO

RelianceHMO is a Y Combinator 2017 Winter Batch company backed by leading Silicon Valley Venture Capitalists that uses software, data science, and telemedicine to make health insurance delightful, affordable and easier to access. Leveraging effective product management and growth strategies, we have successfully positioned ourselves as a competitive player in the Nigerian Health Insurance Industry.

In addition to the quality of our services, we are extremely proud of our dynamic work environment where you can be whoever you want to be. We are a team of bubbly, hardworking individuals whose culture and core values allow us complement each other and collaborate towards common goals.

We are recruiting to fill the position below:

Job Title: Senior Claims Associate

Location: Lagos
Employment type: Full Time
Reports to: Team Lead, Claims and Analytics
Expected Start Date: Q2 2020

The Candidate

• The ideal candidate for this role is someone with a start-up mentality who is ready to work hard and push the limits in ensuring claims vetting and management process is a success.
• The Senior Claims Associate will 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 Team lead, if necessary.
• Carry out 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.
• Escalate fraudulent cases to the Committee of Doctors.
• Update Providers’ dashboard, and implement resolutions.
• Relate with the Customer success team to manage concession requests.
• Relate with technology and design team on any update on the processes regarding the claims of Healthcare Providers.
• Relate with Provider Relations Service unit for tariff agreement.

Minimum Qualifications

• Minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS).
• Relevant work experience in a similar role is an added advantage
• Excellent Numeracy, Analytical and Problem-solving skills.
• Strong ability to make judgement on medical/ surgical cases in relation to benefits listed on enrollee’s benefits.
• Ability to make professional judgement on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.

Application Closing Date
10th April, 2020.