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  • Posted: Feb 3, 2021
    Deadline: Feb 7, 2021
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    We’re a health insurance company that acts like a technology company. We’re using software, data science and telemedicine to make health insurance more affordable, easier to access and more of a delightful experience
    Read more about this company

     

    Claims Examiner

    The Position

    The Contract Claims Examiner role is for a renewable 3-month period. The role holder will be responsible for vetting claims submitted by our Providers to ensure they are error and fraud-free.

    You are a team player – able to work across different stakeholders, communicate expectations openly and clearly, and welcome constructive feedback.

    Key Responsibilities

    • 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.

    Must Haves

    • Minimum of a first degree in a medical or healthcare related field (e.g. Medicine, Dentistry, Nursing, Medical Laboratory sciences, etc)
    • 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.

    Method of Application

    This job has expired. Application is no longer allowed

  • Send your application

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Average Salary at Reliance HMO
₦ 70K from 2 employees
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