RelianceHMO is a Y Combinator 2017 Winter Batch business backed by leading Silicon Valley Venture Capitalists that utilizes software application, information science, and telemedicine to make medical insurance wonderful, inexpensive and simpler to gain access to. Leveraging reliable item management and development techniques, we have actually effectively placed ourselves as a competitive gamer in the Nigerian Health Insurance Industry.
In addition to the quality of our services, we are incredibly pleased with our vibrant workplace where you can be whoever you wish to be. We are a group of bubbly, industrious people whose culture and core worths permit us match each other and work together towards typical objectives.
We are hiring to fill the position listed below:
Job Title: Senior Claims Associate
Location: Lagos
Employment type: Full Time
Reports to: Team Lead, Claims and Analytics
Expected Start Date: Q2 2020
The Candidate
- The perfect candidate for this function is somebody with a start-up mindset who is prepared to strive and press the limitations in making sure claims vetting and management process is a success.
- The Senior Claims Associate will be accountable for vetting all claims sent by our Providers to guarantee they are mistake and scams totally free
- They will handle claims payment and be associated with the resolution of medical cases needing unique attention.
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Key Responsibilities
- Examine Healthcare Providers’ Claims utilizing the Tariff arrangement to identify credibility and payment.
- Decline deceitful Healthcare Providers’ Claims, and state causative factors.
- Forward authorized Claims to Team Lead for evaluation and last approval.
- Investigate complex Claims and intensify to Team lead, if needed.
- Carry out physical assessment at the designated company’s workplace utilizing the list.
- Investigate complex claims by inspecting the case folder and speaking with the Enrollee and the physician.
- Escalate deceitful cases to the Committee of Doctors.
- Update Providers’ control panel, and execute resolutions.
- Relate with the Customer success group to handle concession demands.
- Relate with innovation and style group on any upgrade on the procedures relating to the claims of Healthcare Providers.
- Relate with Provider Relations Service system for tariff arrangement.
Minimum Qualifications
- Minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS).
- Relevant work experience in a comparable function is an included benefit
- Excellent Numeracy, Analytical and Problem-resolving abilities.
- Strong capability to make judgement on medical/ surgical cases in relation to advantages noted on enrollee’s advantages.
- Ability to make expert judgement on protection and non-coverage of care demands per time, based upon the enrollee’s advantages table.
Application Closing Date
10th April, 2020.
How to Apply
Interested and certified candidates should:
Click here to apply online
