job description - Health Service / Quality Assurance Manager
- 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 the Team lead, if necessary.
- Carry out a 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.
- Update Providers’ dashboard, and implement resolutions.
Minimum Qualifications
- 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 enrollee’s benefits.
- Ability to make a professional judgment on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.
- Candidate must have strong computer skills.
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About the company
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Markfema is one of the leading Health Maintenance Organisation (HMO) and a major player in the Nigeria Health Insurance Industry with Head Office in Abuja and offices spread across the country.
