Director of Claims and Tariff Management (Remote) at Reliance Health

Reliance Health uses Technology to Make Healthcare Accessible and Affordable. Through an integrated approach that includes affordable health insurance, telemedicine, and a combination of partner and proprietary healthcare facilities, Reliance Health offers innovative healthcare solutions that meet the needs of emerging markets.

We are recruiting to fill the position below:

Job Title: Director of Claims and Tariff Management

Location: Lagos (Remote)
Employment Type: Full-time

Description

• Reliance Health is seeking a dynamic, data-driven, and experienced Director of Claims and Tariff Management to lead our efforts in optimizing claims processing and tariff management across our international markets, with a primary focus on Egypt and Nigeria. Join Reliance Health and be part of a team dedicated to transforming healthcare services in emerging markets.
• Apply now and contribute to our mission of making quality healthcare accessible and affordable for emerging markets.

Key Responsibilities
Cost Reduction and Fast Reimbursement Cycles:

• Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.

Efficiency Improvement and Unpaid Claims Reduction:

• Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamlining workflows for faster adjudication.

Automation and Rules-Based Claims Processing:

• Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.

Prior Authorization Enhancement:

• Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.

Tariff Management and MER Improvement:

• Drive improvement in turnaround time for tariff renegotiations and enhance Medical Expense Ratios (MER) through data-driven tariff and provider network tiering strategies.

Benefits Design and Operationalization:

• Support the design and operationalization of benefits across our B2B and B2C offerings in multiple international markets, ensuring alignment with regulatory requirements and customer needs.

Fraud, Waste, and Abuse Mitigation:

• Collaborate with provider and case management teams to identify and mitigate claims loss attributed to fraud, waste, and abuse, implementing proactive measures to safeguard against financial losses.

Requirements

• MBBS or Bachelor's Degree in Healthcare Administration, Business Management, with a preferred background of Master’s level studies in data analysis or business administration  
• 8+ years of experience in claims management and tariff negotiation within the healthcare industry
• Proven track record of implementing process improvements to enhance claims efficiency and reduce costs.
• Strong background in data analysis and demonstrated ability to work with data to solve complex problems, utilizing advanced analytical tools and methodologies
• Strong understanding of rules-based automated claims processing systems and prior authorization workflows.
• Experience in tariff negotiation, provider network management, and benefits design across diverse markets.
• Excellent leadership and communication skills, with the ability to collaborate effectively across cross-functional teams.
• Analytical mindset with proficiency in data-driven decision-making and performance metrics evaluation.

Benefits

• Work alongside & learn from best-in-class talent
• Join a market leader within the Insurance space
• Attractive Salary & benefits
• Unlimited leave days
• Free office lunch
• Fantastic work culture
• Work and learn from some of the best in the industry
• Great work-life balance.

Application Closing Date
Not Specified.