Latest Jobs at MetroHealth HMO Limited

Reporting to: Head, HR/Admin

Job Description

• Providing support in the various Human Resource functions which includes but not limited to: HR Operations, recruitment & selection, L & D, performance management and employee relations.
• Assist in ensuring that HR policies and procedures are adhered to
• Liaising with a range of people involved in policy areas and HR operations
• Maintaining, keeping and updating staff records
• Generating Staff attendance reports and leaves records.
• Assist in new employee onboarding program
• Processing of Statutory remittances & utility bill
• Supporting the development and implementation of HR initiatives and systems.
• Overseeing administrative matters including: Vendors, vehicle & drivers management, Supervise and manage all day-to-day office administrative activities

Requirements

• B.Sc / HND in any of the social sciences; further training will be a plus
• Minimum of 4 years of cognate job experience on same role
• Proficient in MS Office suit
• Must be an HR generalist
• Detail-Oriented
• Male preferrable for gender equality

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Job Responsibilities

• Coordinate the management of all Claims processes from submission, initial review, sorting and tracking, pre-processing, adjudication, review, scheduling for payment and then reconciliation and sign off on paid claims.
• Ensure Accurate processing of all claims following proper enrolee verification, enrolee eligibility, PA confirmation, and according to contracted fee schedule with provider.
• Ensure timely processing of claims and appeals on FIFO bases to ensure payment within 30 days of receipt of claims.
• Ensure proper filing and maintenance of claims documents and make sure the information is readily available.
• Conducts a review of processed claims for errors and ensure accuracy of processed claims and preparation of claim schedules for payment
• Responsible for the supervision of the staff in claims unit including training and team building.
• Regular reports on claims status, receipt, processed and payment.
• Monitoring and evaluation of utilization patterns by
• Analysis of preauthorization reports to identify regional and provider specific trends and propose process changes and policies for effective utilization management
• Analysis of claims reports to identify regional and provider specific trends and propose process changes and policies for effective utilization management
• Regular reports on claims status, trends and utilization patterns.
• Any other activity as assigned by management

Requirements

• Minimum B.Sc. / HND in any discipline
• Minimum of five (5) years of cognate experience on same role and in the HMO industry