Vetting Officer - HMO at Zuma Health Trust Limited

Job Description

• Examine bills and claims from Health Care Providers (HCPs) and enrollees using agreed Tariff to ensure authenticity.
• Investigate suspicious claims through Enrollee contact, case folder checks and otherapproved protocols
• Escalate complicared fraudulent claims to QA Team lead.
• Forward approved Claims to Team Lead for review and final approval.
• Generate or prompt payment advice to HCPs for FFS payments made .
• Undertake physical inspection and routine visitat providers' facilities using service checklist.
• Participate in the resolution of medical claims cases requiring rigorous negotiations
• Undertake reconciliation of accounts with HCPs on claims

Requirements

• First Degree or its equivalent in Nursing or a related field
• Must have a minimum of 2 years vetting experience with a Health Maintenance Organization (HMO)
• Degree or its equivalent qualification in nursing, midwifery or any other relevant field
• Certification in professional membership in related bodies
• Good knowledge of excel, word and data analytics
• At least 3years post NYSC experience
• Must have minimum of 2 years vettingexperience with a Health Maintenance Organization
• Up to date Nursing and or midwifery council of Nigeria certification
• Attendance of relevant course workshop and seminars I related fields.

Remuneration
N140,000 - N170,000 Monthly (based on experience).