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.