Markfema Nigeria Limited’s job vacancy, Career and Recruitment
Job title : Health Service / Quality Assurance Manager jobs in Abuja
Job Location : Abuja
Deadline : February 14, 2022
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Reporting to: MD / CEO
- Shall be ready to work hard and push the limits in ensuring claims vetting and fluent management process.
- Shall oversee thevetting of 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 ProvidersÛª Claims using the Tariff agreement to determine authenticity and payment.
- Decline fraudulent Healthcare ProvidersÛª 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 providerÛªs office using the checklist.
- Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
- Update ProvidersÛª dashboard, and implement resolutions.
- Minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS) with a post-graduate qualifications
- 10 years of work experience.
- Previous relevant work experience in a similar role is highly desired
- Excellent Numeracy, Analytical and Problem-solving skills.
- Strong ability to make judgments on medical/ surgical cases in relation to benefits listed on enrolleeÛªs benefits.
- Ability to make a professional judgment on coverage and non-coverage of care requests per time, based on the enrolleeÛªs benefits table.
- Candidate must have strong computer skills.
*Medical / Healthcare jobs in Nigeria
*Medical / Healthcare jobs in Abuja
*Health Service / Quality Assurance Manager in Abuja
How to Apply for this Offer
Interested and Qualified Candidates should Click here to Apply online