HMO Claims Officer at LD&D Consulting

Job Summary

• Our reliable client in the healthcare company  is hiring an HMO Officer- to manage HMO authorizations, claims processing, and receivables to ensure accurate and timely payments while maintaining billing transparency and patient satisfaction.

Responsibilities

• Process HMO authorizations, pre-approvals, and claims according to provider agreements.
• Verify patient eligibility and benefits before service delivery.
• Submit clean claims and follow up on pending/denied claims until resolved.
• Reconcile monthly HMO payments against services rendered and flag discrepancies.
• Maintain updated records of HMO tariffs, policies, and agreements.
• Liaise with HMOs, patients, and internal teams to resolve billing issues.
• Prepare weekly and monthly receivables reports for management.

Requirements

• HND/B.Sc in Accounting, Finance, Health Administration, or related field.
• Minimum 2 years’ experience in HMO billing, receivables, or revenue cycle in a hospital/diagnostics setting.
• Working knowledge of NHIA guidelines and HMO processes in Nigeria.
• Proficient in Excel and hospital management/billing software.
• Strong attention to detail, integrity, and follow-up skills.