Claims Officer at Prepaid Medicare Services Limited

Prepaid Medicare Services Limited is a leading Health Maintenance Organisation (HMO) and a major player in the Nigeria Health Insurance Industry with Head Office in Abuja.

We are recruiting to fill the position below:

Job Title: Claims Officer

Location: Abuja (FCT)
Employment Type: Full-time
Job Ref: CO-ABJ-02-22

Job Summary

Manages and administrates direction of billing for medical services provided to patients in order to ensure they receive care in the most efficient manner.
They work to plan, organize, and direct a medical claims department.
A healthcare Claims Manager also coordinates with representatives of outside agencies, and members of the public by providing accurate information in an efficient manner.

Key Responsibilities
Key responsibilities include the following, other duties may be assigned:

Examine Healthcare Providers’ Claims using Tariff agreement to determine authenticity & payment.
Forward approved Claims to Team Lead for review and final approval.
Investigate complicated Claims and escalate to Team lead, if necessary.
Investigate complicated claims by speaking to Enrollees and providers.
Update Providers’ dashboard and implement resolutions.
Decline fraudulent Healthcare Providers’ Claims, and state causative reasons.
Escalate fraudulent cases to the Committee of Doctors.

Requirements

Must be a Certified Registered Nurse, B.Sc in Nursing with 3 to 5 years of experience
Excellent numeracy, analytical and problem-solving skills.
Strong ability to make a judgement on medical/ surgical cases in relation to enrollee’s benefits.
Ability to make a professional judgement on coverage and non-coverage of care requests per time.
Excellent interpersonal and communication skills.
Must be willing to resume work 3 days after interview.
Must be willing to work 24 hours
Masters in MPH and MBA is a vital advantage
Knowledge of the operations of the National Health Insurance Scheme (NHIS) and Health Maintenance Organization will be an added advantage
Excellent customer relationship skills
Good communication/presentation skills (both oral and written)
Ability to communicate effectively in both oral and written English language
Must be a team player, able to build and maintain effective and collaborative sales and marketing network
Must be able to take responsibility and demonstrate high level of integrity in dealing with all stakeholders

Required Skills:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and/or ability required:

Good Typing Skills
Attention to detail
Professional development through participation in continuing education and professional Organizations.
Good verbal and written communication skills
Must be Conversant with the HMO processes and Maintenance
Must also be good in Coordination, Listening, Scheduling and Teamwork
Must possess good administrative skills
Superior problem-solving skills
Ability to explain detailed instructions articulately and clearly
Ability to analyse Information promptly
Exceptional customer services skills
Proficient in relevant computer applications
Knowledge of customer service principles and practices
Knowledge of call centre telephony and technology
Relevant product knowledge