Industry: Health Maintenance Organization (HMO)
Salary: Very Attractive and Competitive
Job Summary
The Internal Auditor will be responsible for ensuring that all financial, operational, and regulatory processes within the organization comply with the National Health Insurance Authority (NHIA) Act, internal policies, and industry standards. The role involves conducting routine audits, identifying risks, preventing fraud, strengthening internal controls, and ensuring that provider claims, enrollee management processes, and financial transactions are accurate, transparent, and compliant.
Key Responsibilities
Financial and Operational Audit
- Conduct periodic audits of financial transactions including premiums, capitation, claims, and provider payments.
- Review financial statements and accounting systems for accuracy and compliance.
- Verify revenue inflows, expenditures, reconciliations, and budget performance.
Compliance & Regulatory Monitoring
- Ensure compliance with the NHIA Act (2022), NHIA guidelines, and other regulatory requirements.
- Review internal controls and procedures to ensure alignment with statutory standards.
- Monitor and follow up on implementation of audit recommendations.
Claims & Medical Operations Audit
- Audit healthcare provider claims to detect fraud, abuse, and irregularities.
- Review pre-authorizations, case management records, and enrollee utilization.
- Ensure proper documentation of tariff payments, encounter data, and reimbursement processes.
Risk Management
- Identify operational, financial, and compliance risks.
- Recommend risk mitigation strategies and improve control mechanisms.
- Conduct fraud risk assessments and support investigations.
Performance Audit
- Audit internal departments (IT, Provider Relations, Call Center, Enrolment, Underwriting, Finance, etc.) for efficiency.
- Evaluate adequacy of internal controls and recommend improvements.
Reporting & Documentation
- Prepare detailed audit reports with findings and recommendations.
- Maintain proper documentation for audit activities and investigations.
- Present audit findings to management and track implementation of corrective actions.
Investigation & Special Assignments
- Investigate suspected fraud, misconduct, or policy breaches.
- Conduct spot checks at hospitals, client locations, and operational sites.
- Support management with ad-hoc audits and strategic initiatives.
Requirements
- Bachelor’s degree in Accounting, Finance, Economics, Business Administration, or related field.
- Professional certifications such as ICAN, ACCA, CISA, CIA, or CRMA (completed or in progress) are required.
- Minimum of 8 years’ audit experience, preferably within: HMO/Health Insurance, Healthcare/Provider Audit, Financial Services or Insurance.
- Strong knowledge of NHIA regulations and HMO operations is an added advantage.
Skills & Competencies:
- Strong analytical and investigative abilities.
- Sound understanding of internal control frameworks.
- Ability to detect fraud, inconsistencies, and operational weaknesses.
- Proficiency in Microsoft Excel, audit software, and accounting tools.
- Excellent reporting, communication, and presentation skills.
- High level of integrity, confidentiality, and professionalism.
- Ability to work independently and manage multiple priorities.
Compensation & Benefits
- Competitive salary package.
- Health insurance coverage.
- Professional development and continuous audit training.
- Transport allowance or fieldwork benefits (where applicable).
- Performance-based incentives and bonuses.
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