Medical Claims Processing Executive at Masslife Healthcare Limited

At Masslife Healthcare Limited (a health maintenance organization), we are dedicated to providing accessible, high-quality, customer-centric health insurance solutions to our enrollees. We are committed to delivering top-tier, affordable, and accessible healthcare to our public and private sector clients. With a strong presence nationwide and a 24/7/365 operational model, we pride ourselves on exceptional service delivery, innovation, and a customer-centric approach.

We are recruiting to fill the position below:

Job Title: Medical Claims Processing Executive

Location: Abuja (FCT)

Job Description

• We are seeking a detail-oriented, analytical medical claims processing executive to join our growing claims management team. The Medical Claims Processing Executive will review, validate, and adjudicate medical claims to ensure accuracy, compliance with policy terms, and timely reimbursement.
• You will serve as a crucial bridge between healthcare providers, enrollees, and our company to ensure efficient service delivery.

Key Responsibilities

• Claims Adjudication: Review and process medical claims (inpatient/outpatient) in accordance with company policies and legal regulations.
• Documentation Verification: Audit provider bills, ensuring consistency with medical reports, prescriptions, and diagnostics.
• System Utilization: Accurately enter, update, and manage data within our electronic health records (EHR) and claims management software.
• Discrepancy Resolution: Research and resolve discrepancies in claims, including following up on outstanding information from hospitals or members.
• Fraud Detection: Identify and mitigate potential fraud and abuse in claims, implementing effective management practices.
• Customer Support: Handle inquiries from policyholders and providers regarding claim status with professionalism and empathy.
• KPI Management: Meet strict turnaround times (TAT) and quality standards for claim processing.

Requirements & Qualifications

• Education: Bachelor’s Degree in Health Information Technology, Nursing, Pharmacy, or a related field.
• Experience: Experience in medical claims processing, medical billing, or TPA roles, medical bill audits, and coding knowledge of ICD-10.
• Technical Skills: Proficiency in MS Office (especially Excel), e-Claims Processing System, data analysis, visualization, and reporting.
• Industry Knowledge: Strong understanding of medical terminology, HMO operations, and insurance plans.
• Other Skills: Exceptional attention to detail, strong analytical thinking, and the ability to work under pressure.

Application Closing Date
20th March, 2026.