Claims Supervisor at MetroHealth HMO

MetroHealth HMO| Job Title: Claims Supervisor | Job Location: Lagos
Employment Type: Full-time
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Job Responsibilities

  • 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.
  • 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.
  • 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.
  • Any other activity as assigned by management

Requirements

  • Minimum B.Sc. / HND in any discipline
  • Minimum of five (5) years of cognate experience on same role and in the HMO industry

Application Closing Date
8th January, 2021.

How to Apply
Interested and qualified candidates should send their CV to[email protected] using the Job title as the subject of the mail.

Note

  • Experience in HMO industry is compulsory
  • Only shortlisted candidates will be contacted