Claims Examiner at Reliance Healthwork Reliance HealthplaceLagosDate Posted: 2021-02-03
Reliance Health (www.reliancehmo.com) is a healthcare company using technology to make healthcare more affordable and accessible. We are hiring a Claims Examiner in Lagos (Gbagada)
Employment Type: Contract
Duration: 3 month
- The Contract Claims Examiner role is for a renewable 3-month period. The role holder will be responsible for vetting claims submitted by our Providers to ensure they are error and fraud-free.
- You are a team player - able to work across different stakeholders, communicate expectations openly and clearly, and welcome constructive feedback.
- Examine Healthcare Providers’ Claims using Tariff agreement to determine authenticity & payment.
- Forward approved Claims to Team Lead for review and final approval.
- Investigate complicated Claims and escalate to Team lead, if necessary.
- Investigate complicated claims by speaking to Enrollees and providers.
- Update Providers’ dashboard and implement resolutions.
- Decline fraudulent Healthcare Providers’ Claims, and state causative reasons.
- Escalate fraudulent cases to the Committee of Doctors.
- Minimum of a first degree in a Medical or Healthcare related field (e.g. Medicine, Dentistry, Nursing, Medical Laboratory Sciences, etc)
- Excellent numeracy, analytical and problem-solving skills.
- Strong ability to make a judgement on medical/ surgical cases in relation to enrollee’s benefits.
- Ability to make a professional judgement on coverage and non-coverage of care requests per time.
- Excellent interpersonal and communication skills.
How to Apply
Interested and qualified candidates should apply on or before 7th February, 2021.
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