Job Openings at Reliance HMO

• The Case Management Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network.

Responsibilities

• Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
• Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
• Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
• Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency
• Case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions

Requirements

• Bachelor's degree in medicine, nursing, or related disciplines
• Knowledge of healthcare operations, fraud prevention, and regulatory compliance.
• Experience in conducting fraud, waste, and abuse investigations is preferred.
• Knowledge of emergency management protocols and procedures.
• Familiarity with mortality review processes and quality improvement initiatives.
• Knowledge of legal and regulatory requirements related to fraud, waste, and abuse investigations, emergency care, and case management.
• Professional certifications in fraud examination, case management, or related fields (e.g., Certified Fraud Examiner, Certified Case Manager) are advantageous.

go to method of application »

• The Case Management Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network.

Responsibilities

• Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
• Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
• Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
• Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency
• Case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions

Requirements

• Bachelor's degree in medicine, nursing, or related disciplines
• Knowledge of healthcare operations, fraud prevention, and regulatory compliance.
• Experience in conducting fraud, waste, and abuse investigations is preferred.
• Knowledge of emergency management protocols and procedures.
• Familiarity with mortality review processes and quality improvement initiatives.
• Knowledge of legal and regulatory requirements related to fraud, waste, and abuse investigations, emergency care, and case management.
• Professional certifications in fraud examination, case management, or related fields (e.g., Certified Fraud Examiner, Certified Case Manager) are advantageous.

go to method of application »

• The Case Management Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network.

Responsibilities

• Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
• Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
• Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
• Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency
• Case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions

Requirements

• Bachelor's degree in medicine, nursing, or related disciplines
• Knowledge of healthcare operations, fraud prevention, and regulatory compliance.
• Experience in conducting fraud, waste, and abuse investigations is preferred.
• Knowledge of emergency management protocols and procedures.
• Familiarity with mortality review processes and quality improvement initiatives.
• Knowledge of legal and regulatory requirements related to fraud, waste, and abuse investigations, emergency care, and case management.
• Professional certifications in fraud examination, case management, or related fields (e.g., Certified Fraud Examiner, Certified Case Manager) are advantageous.

go to method of application »

• The Case Management Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network.

Responsibilities

• Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
• Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
• Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
• Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency
• Case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions

Requirements

• Bachelor's degree in medicine, nursing, or related disciplines
• Knowledge of healthcare operations, fraud prevention, and regulatory compliance.
• Experience in conducting fraud, waste, and abuse investigations is preferred.
• Knowledge of emergency management protocols and procedures.
• Familiarity with mortality review processes and quality improvement initiatives.
• Knowledge of legal and regulatory requirements related to fraud, waste, and abuse investigations, emergency care, and case management.
• Professional certifications in fraud examination, case management, or related fields (e.g., Certified Fraud Examiner, Certified Case Manager) are advantageous.

go to method of application »

• The Case Management Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network.

Responsibilities

• Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
• Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
• Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
• Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency
• Case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions

Requirements

• Bachelor's degree in medicine, nursing, or related disciplines
• Knowledge of healthcare operations, fraud prevention, and regulatory compliance.
• Experience in conducting fraud, waste, and abuse investigations is preferred.
• Knowledge of emergency management protocols and procedures.
• Familiarity with mortality review processes and quality improvement initiatives.
• Knowledge of legal and regulatory requirements related to fraud, waste, and abuse investigations, emergency care, and case management.
• Professional certifications in fraud examination, case management, or related fields (e.g., Certified Fraud Examiner, Certified Case Manager) are advantageous.

go to method of application »

We are currently hiring a Global Provider Lead role to lead and streamline our provider network operations across different markets. The goal is to build a consistent and efficient approach to managing providers, ensuring smooth processes and strong relationships in both current and new markets.

• Develop and implement processes that delight providers on our network as measured by feedback surveys.
• Harmonize provider relationship management process across all markets to similarly address the provider journey map, address bottlenecks and alleviate pain points while adapting and ensuring compliance with local regulations.
• Leverage data and analytics to monitor provider performance, identify emerging trends and risks, and inform continuous improvements to relationship management strategies.
• Develop and implement a strategy to measure and improve the Reliance Health member experience while seeking care at providers on the Reliance Health network across all markets.
• Develop and implement incentives for providers to minimize wait and maximize medical quality for Reliance Health members.
• Collaborate closely with Claims, Tariffs, and Case Management teams to ensure provider-facing processes are aligned, responsive, and support efficient claims processing, cost control, and high-quality care delivery.
• Lead and manage the provider acquisition and relationship management team to drive high performance across assigned portfolios, using data to track and improve clinical quality, member satisfaction, and adherence to Reliance Health processes and standards across all markets.
• Ensure timely and effective resolution of internal and external escalations related to provider issues, leveraging root cause analysis to prevent recurrence and improve provider touchpoints.
• Strengthen provider onboarding and engagement processes to build consistent alignment with operational expectations, reducing instances of long wait times, denied care, and poor member experiences.
• Use performance dashboards and data insights to set clear targets, monitor outcomes, and continuously coach the team to optimize provider compliance, responsiveness, and patient-centered service delivery.

Requirements

• At least 8–10 years of experience in healthcare operations, provider network management, or a related field.
• Proven track record of leading multi-market operations or managing stakeholders across multiple African countries.
• Experience in building and scaling systems, tools, or teams in a process-oriented environment.
• Strong understanding of the Nigerian healthcare landscape, with relevant contacts or working experience.
• Experience working in or with private healthcare providers, HMOs, or health tech companies is a strong plus.
• Strong negotiation and relationship management skills, especially with healthcare providers or partners.
• Candidate must be based in Nigeria; the role is remote within Nigeria.