Claims Supervisor at MetroHealth HMO Limited

MetroHealth HMO is a Nigerian leading health management organization with an aim to render unparalleled technology-based and comprehensive primary, secondary, and tertiary health care services across the country. MetroHealth was registered by the regulatory authority, the National Health Insurance Scheme (NHIS) to operate as a national HMO in 2013.

With over 650 partner hospitals, we are committed to rendering world-class preventive and curative health care services to our clients in the easiest and stress-free method. We understand that every client is unique and deserves flexible, specialized solutions; therefore we embrace an individualized approach towards taking excellent care of our clients.

We are big on maximizing the blessings of technology to render 21st century-based health services making sure our clients are in the best state of health.

We are recruiting to fill the position below:

Job Title: Claims Supervisor

Location: Lagos
Employment Type: Full-time

Job Responsibilities

Coordinate the management of all Claims processes from submission, initial review, sorting and tracking, pre-processing, adjudication, review, scheduling for payment and then reconciliation and sign off on paid claims.
Ensure Accurate processing of all claims following proper enrolee verification, enrolee eligibility, PA confirmation, and according to contracted fee schedule with provider.
Ensure timely processing of claims and appeals on FIFO bases to ensure payment within 30 days of receipt of claims.
Ensure proper filing and maintenance of claims documents and make sure the information is readily available.
Conducts a review of processed claims for errors and ensure accuracy of processed claims and preparation of claim schedules for payment
Responsible for the supervision of the staff in claims unit including training and team building.
Regular reports on claims status, receipt, processed and payment.
Monitoring and evaluation of utilization patterns by
Analysis of preauthorization reports to identify regional and provider specific trends and propose process changes and policies for effective utilization management
Analysis of claims reports to identify regional and provider specific trends and propose process changes and policies for effective utilization management
Regular reports on claims status, trends and utilization patterns.
Any other activity as assigned by management