HMO Claims Officer at Clinix Healthcare Nigeria

Clinix Healthcare has 40 years of qualitative experience in Medical and Diagnostic services with over 120 centers across Africa. The state-of-the art Diagnostic Centre represents a milestone towards fulfilling Clinix strategic objectives in providing a world class integrated health system that ensures excellence in health and healthcare for all as a globally recognized destination for healthcare. Clinix Healthcare Nigeria is the first investment in West Africa. The Principal investor is Greenlife Pharmaceuticals and Bliss Gvs Pharmaceuticals. Both companies have outstanding repute in the Nigerian Healthcare industry.

We are recruiting to fill the position below:

Job Title: HMO Claims Officer

Location: Lagos
Employment Type: Full-time

Job Summary 

• Clinix Healthcare is seeking a diligent and detail-oriented HMO Claims Officer to join our Health Maintenance Organization (HMO) operations team.
• We are dedicated to delivering efficient, accurate, and patient-centered healthcare services and are looking for a professional passionate about claims processing, provider relations, and ensuring smooth reimbursement workflows.

Responsibilities

• Process, verify, and adjudicate health insurance claims submitted by providers and patients in line with HMO guidelines and policy terms.
• Review medical bills, treatment authorizations, and supporting documents for completeness, accuracy, and medical necessity.
• Coordinate with healthcare providers, hospitals, and diagnostic centers to resolve claim queries, request additional information, and ensure timely submissions.
• Calculate benefits, apply deductibles, co-payments, and exclusions correctly, and prepare payment/remittance advice.
• Maintain accurate records of claims, approvals, rejections, and payments in the organization’s claims management system.
• Investigate and resolve disputed or rejected claims, including escalation where necessary.
• Ensure strict compliance with NHIS regulations, internal policies, and data protection standards.
• Generate periodic claims reports and provide insights to support management decisions and fraud detection.  

Qualifications

• Bachelor’s degree in Health Insurance, Business Administration, Accounting, Nursing, Public Health, or a related field.
• Minimum of 2–3 years of relevant experience in HMO claims processing, health insurance adjudication, or medical billing.
• Certification in Health Insurance or Claims Management (e.g., from CIIN or relevant bodies) is an added advantage.
• Valid professional certification or license where applicable (for clinical background candidates).

Requirements & Skills:

• Strong understanding of health insurance claims processing and HMO operations.
• Excellent attention to detail and analytical skills for reviewing complex medical and billing documentation.
• Good knowledge of medical terminology, ICD-10 coding, and NHIS tariff guidelines.
• Proficient in the use of claims management software and Microsoft Office Suite.
• Strong communication and interpersonal skills for liaising with providers and internal teams.
• Ability to multitask, meet deadlines, and work efficiently under pressure.
• High level of integrity, confidentiality, and ethical conduct in handling sensitive patient and financial data.

Application Closing Date
31st March, 2026.

Method of Application
Interested and qualified candidtes should send their CV to: Admin@clinixhealthcare.com.ng and copy: hr@clinixhealthcare.com.ng using the job title as the subject of the mail.