Claims Executive at MetroHealth HMO Limited

MetroHealth HMO Ltd is seeking a qualified and experienced Claims Executive to join our dynamic team.

Job Summary

The Claims Executive will be responsible for claims processing, vetting, analysis, reconciliation, and ensuring timely and accurate claims administration in line with organizational standards.

Requirements

• Must be a Registered Nurse (RN) with relevant professional certification
• Minimum of 3 years’ relevant experience in the HMO/Health Insurance space
• Strong knowledge of medical claims processing and tariff interpretation
• Good understanding of NHIA guidelines and healthcare claims management
• Excellent analytical and reconciliation skills
• High level of accuracy and attention to detail
• Proficiency in Microsoft Office and claims management systems
• Strong communication and interpersonal skills

Key Responsibilities

• Vet and process provider claims accurately and promptly
• Review claims for compliance with benefit plans and tariffs
• Liaise with healthcare providers on claims-related issues
• Conduct claims reconciliation and reporting
• Identify discrepancies and recommend corrective actions
• Ensure adherence to internal policies and regulatory requirements