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  • Posted: Apr 16, 2024
    Deadline: Not specified
  • Never pay for any CBT, test or assessment as part of any recruitment process. When in doubt, contact us

    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


    Director of Claims and Tariff Management


    Reliance Health is seeking a dynamic, data-driven, and experienced Director of Claims and Tariff Management to lead our efforts in optimizing claims processing and tariff management across our international markets, with a primary focus on Egypt and Nigeria. Join Reliance Health and be part of a team dedicated to transforming healthcare services in emerging markets. Apply now and contribute to our mission of making quality healthcare accessible and affordable for emerging markets.

    Key Responsibilities:

    Cost Reduction and Fast Reimbursement Cycles:

    • Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.

    Efficiency Improvement and Unpaid Claims Reduction:

    • Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamlining workflows for faster adjudication.

    Automation and Rules-Based Claims Processing:

    • Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.

    Prior Authorization Enhancement:

    • Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.

    Tariff Management and MER Improvement:

    • Drive improvement in turnaround time for tariff renegotiations and enhance Medical Expense Ratios (MER) through data-driven tariff and provider network tiering strategies.

    Benefits Design and Operationalization:

    • Support the design and operationalization of benefits across our B2B and B2C offerings in multiple international markets, ensuring alignment with regulatory requirements and customer needs.

    Fraud, Waste, and Abuse Mitigation:

    • Collaborate with provider and case management teams to identify and mitigate claims loss attributed to fraud, waste, and abuse, implementing proactive measures to safeguard against financial losses.


    • MBBS or Bachelor's degree in Healthcare Administration, Business Management, with a preferred background of master’s level studies in data analysis or business administration  
    • 8+ years of experience in claims management and tariff negotiation within the healthcare industry
    • Proven track record of implementing process improvements to enhance claims efficiency and reduce costs.
    • Strong background in data analysis and demonstrated ability to work with data to solve complex problems, utilizing advanced analytical tools and methodologies
    • Strong understanding of rules-based automated claims processing systems and prior authorization workflows.
    • Experience in tariff negotiation, provider network management, and benefits design across diverse markets.
    • Excellent leadership and communication skills, with the ability to collaborate effectively across cross-functional teams.
    • Analytical mindset with proficiency in data-driven decision-making and performance metrics evaluation.

    Method of Application

    Interested and qualified? Go to Reliance HMO on to apply

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