MetroHealth HMO is a Nigerian leading health management organization with an aim to render unparalleled technology-based and comprehensive primary, secondary, and tertiary health care services across the country. MetroHealth was registered by the regulatory authority, the National Health Insurance Scheme (NHIS) to operate as a national HMO in 2013.
With over 650 partner hospitals, we are committed to rendering world-class preventive and curative health care services to our clients in the easiest and stress-free method. We understand that every client is unique and deserves flexible, specialized solutions; therefore we embrace an individualized approach towards taking excellent care of our clients.
We are big on maximizing the blessings of technology to render 21st century-based health services making sure our clients are in the best state of health.
We are recruiting to fill the position below:
Job Title: Claims Supervisor
Employment Type: Full-time
- 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.
- 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.
- 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.
- Any other activity as assigned by management
- Minimum B.Sc. / HND in any discipline
- Minimum of five (5) years of cognate experience on same role and in the HMO industry
How to Apply
Interested and qualified candidates should send their CV to: firstname.lastname@example.org using the Job title as the subject of the mail.
- Experience in HMO industry is compulsory
- Only shortlisted candidates will be contacted
- we are an equal opportunity employer and is committed to building a diverse workforce. While all applications will be acknowledged.
• We reserves the right to select one or more candidates from this vacancy announcement
• We may also retain applications and consider candidates applying to this post for other similar positions at the same grade level and with similar job description, experience and educational requirements
• Qualified female candidates are strongly encouraged to apply
• Scam Warning:
We do not charge any application, processing, training, interviewing, testing or other fee in connection with the application or recruitment process. Should you receive a solicitation for the payment of a fee, please disregard it.
• Furthermore, please note that emblems, logos, names and addresses are easily copied and reproduced.
• Therefore, you are advised to apply particular care when submitting personal information on the web
• Only shortlisted candidates will be invited for interview or the next stage of the recruitment process.
Application Deadline 8th January, 2021.