Sigma Consulting is one of the fast growing Nigeria’s management & healthcare consulting firms. We work with top executives to help them make better decisions, convert those decisions to actions and deliver the sustainable success they desire. For more than 5 years, we’ve been passionate about achieving better results for our clients, results that go beyond financials and are uniquely tailored, pragmatic, holistic , sustainable and clients oriented.
Sigma has more than 41 consultants in major industries and provided services in 3 countries.
We are recruiting to fill the position below:
Job Title: Quality Assurance Officer
Location: Lagos
Job Type: Full Time
Job Summary
The ideal candidate must be a Professional Doctor, who would work with our Provider Relations Team, Customer Success Teams, Claims and Underwriting teams and make sure that excellent and high-quality service is provided to clients across all provider networks while ensuring resolution of complicated claims and limiting fraud.
He /She will have major responsibility for managing the relationship between the company, our providers, and our enrollees.
The ideal candidate would be demanded to track waste, fraud, and/or error from initial point of access to care by enrollees to final claims filing by the Provider.
Responsibilities
Work with the Provider Team to ensure the minimum standards for quality are met before sign up.
Inspect and evaluate hospitals to ensure compliance with basic standards.
Carry out physical inspection at the assigned providers office using the checklist.
Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
Escalate fraudulent cases to the Committee of Doctors.
Update Providers dashboard, and implement resolutions.
Recommend changes to improve the efficiencies in the systems and process of the Provider Relations as well as the Claims team.
Recognize and fix areas of weakness in the system to limit potential for fraud
Carry out regular hospital quality checks.
Develop and implement survey tools for patient feedback and communicating data results to Providers to ensure continuous improvement.
Visit patients in the hospital to ensure they are getting medically necessary care, quality care and that the care is being delivered as efficiently and economically as possible.
Anticipates the patient's future health care needs and tries to put in place mechanisms to meet those needs as efficiently as possible
Ensure efficiency and cost-effectiveness of medical services provided to clients
Takes initiative to present ideas and suggestions to leadership
Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops.
Perform all other duties as assigned.
Requirements
Minimum 2-year experience in Clinical Practice or Quality assurance role
Must be a Male Medical Doctor
Strong ability to make judgment on medical/ surgical cases in relation to benefits listed on enrollee plan.
Ability to make a professional judgment on coverage and non-coverage of care requests per time, based on the enrollee benefits table.
Exceptional problem solving and analytical skills
Excellent communication and presentation skills
Knowledge of, and sensitivity to, cultural and language differences.
A demonstration of curiosity, love for learning, execution and speed.
Skills:
Confidence.
Excellent technical skills.
Good numerical skills and an understanding of statistics.