Claims Supervisor at MetroHealth HMO Limited

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

Location: Lagos
Employment Type: Full-time

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.