• Claims Examiner at Reliance Health

    work Reliance Health
    Date 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 Position

    • 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.

    Key Responsibilities

    • 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.

    Must Haves

    • 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.

    work Reliance Health

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