Head of Medical Services and Quality Assurance at Prepaid Medicare Services Limited

Job Ref: HMS/QA-ABJ-09-17
Location: Abuja

Summary

• Coordination of health care provider and work site clinics, Manage relationship with Hospital and Clinics, Manage HMO quality initiatives, Coordinate disease management, health promotion and disease prevention of the organisation.
• Work with marketing team to develop new products, Carry out provider mapping, Carry out provider accreditation with medical unit, Vetting of fee for service bills, and resolve grievances arising in the course of care, the medical/quality assurance reports and other duties that is assigned from time to time by the Executive Director.

Key Responsibilities
Include the following:

• Other duties may be assigned.
• Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
• Explain benefits, eligibility status, enrolment processing procedures and status of authorizations and referrals to callers.
• Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls).
• Process complaints, following established guidelines.
• Maintain knowledge of National guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
• Identify and escalate priority issues.

Requirements

• Minimum of first Degree or its equivalent in Medicine or Health related field.
• Certification in or professional membership of health, management or related bodies
• Knowledge of statistical/epidemiological tools such as SPSS, Epiinfo. Ms power point etc
• Minimum of 10 years experience post NYSC
• Minimum of 5 years experience in relevant and related field
• Attendance of related Courses/ workshops/seminars etc
• HMO Experience is required
• Knowledge of the operations of the National Health Insurance Scheme (NHIS)
• 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
• 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.