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  • Posted: Jul 20, 2021
    Deadline: Aug 3, 2021
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  • Markfema Nigeria Limited is a health maintenance organization in Nigeria which started operations in 2005 and is duly accredited by the National Health Insurance Scheme (the regulatory body responsible for the implementation of the Social Health Insurance Scheme in Nigeria).
    Read more about this company

     

    Health Service / Quality Assurance Officer

    Reports to: Head of Operations / Health Services

    The Candidate

    • Shall be ready to work hard and push the limits in ensuring claims vetting and fluent management process.
    • Shall be responsible for vetting all claims submitted by our Providers to ensure they are error and fraud-free
    • They will manage claims payment and be involved in the resolution of medical cases requiring special attention.

    Key Responsibilities

    • 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).
    • 4 years work experience.
    • Additional post-graduate qualifications will be an advantage
    • Previous relevant work experience in a similar role will be an added advantage
    • 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.

    Method of Application

    Note: Only successful candidates will be contacted.

    Interested and qualified? Go to Markfema Nigeria Limited on form.jotform.com to apply

    Note: Never pay for any training, certificate, assessment, or testing to the recruiter.

  • Send your application

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