Markfema Nigeria Limited is one of the leading Health Maintenance Organisation (HMO) and a major player in the Nigeria Health Insurance Industry with Head Office in Abuja and offices spread across the country.
Due to steady growth and expansion, we seek competent, experienced, and dedicated individuals to fill the vacant position below:
Job Title: Health Service / Quality Assurance Officer
Location: Abuja (FCT)
Employment Type: Full-time
Reports to: Head of Operations / Health Services
- Shall be ready to work hard and push the limits in ensuring claims vetting and fluent management process.
- Shall be responsible for vetting all claims submitted by our Providers to ensure they are error and fraud-free
- They will manage claims payment and be involved in the resolution of medical cases requiring special attention.
- Examine Healthcare Providers’ Claims using the Tariff agreement to determine authenticity and payment.
- Decline fraudulent Healthcare Providers’ Claims and state causative reasons.
- Forward approved Claims to Team Lead for review and final approval.
- Investigate complicated Claims and escalate to the Team lead, if necessary.
- Carry out a physical inspection at the assigned provider’s office using the checklist.
- Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
- Update Providers’ dashboard, and implement resolutions.
- Minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS).
- 4 years work experience.
- Additional post-graduate qualifications will be an advantage
- Previous relevant work experience in a similar role will be an added advantage
- Excellent Numeracy, Analytical and Problem-solving skills.
- Strong ability to make judgments on medical/ surgical cases in relation to benefits listed on enrollee’s benefits.
- Ability to make a professional judgment on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.
- Candidate must have strong computer skills.
Application Closing Date
3rd August, 2021.
How to Apply
Interested and qualified candidates should:
Note : Only successful candidates will be contacted.