Closed File Review Officer (Rivers) at AXA Mansard Insurance Plc

AXA Mansard is one of the foremost Financial Institutions in Nigeria, that has been offering world class financial services over the years.

We are recruiting to fill the position below:

Job Title: Closed File Review Officer

Location: Rivers
Job type: Full time

Job Description

• Responsible for post-payment reviews of claims to identify anomalies, errors, or fraudulent activities that may have bypassed initial scrutiny.
• The officer will ensure compliance, recover undue payments, and recommend process improvements

Key Responsibilities

• Review closed claims for medical fraud, billing anomalies, and coding errors.
• Identify patterns such as excessive billing, duplicate submissions, or unauthorized charges.
• Collaborate with claims, fraud, and recovery teams to validate findings and assess recovery actions.
• Engage with healthcare providers during audits, closeout discussions, and recovery negotiations.
• Represent the audit team in provider-related escalations and ensure due process is followed.
• Liaise with internal departments such as Claims, Healthcare Services, Provider Relations, Operational Risk, and Internal Control.
• Analyse claims data to detect emerging fraud patterns and trends.
• Recommend proactive measures and prevention strategies to reduce fraud exposure.
• Track and report audit recoveries using relevant platforms and systems.
• Contribute to the development and refinement of FWA SOPs, red flag documents, and audit workflows.
• Review and validate audit reports for accuracy, clarity, and actionable recommendations.
• Lead or support initiatives like the creation of an audit glossary, operational guide, or resource hub.
• Supervise daily activities of the Audit Team, ensuring audit targets and timelines are met.
• Conduct all other duties that will be assigned from time to time by the Line Manager(s) from time to time.

Requirements

• Academic / Professional: MBBS Degree from a reputable Tertiary Institution. Data Analytics knowledge/qualification will be an added advantage.
• Work experience: 1 - 4 Years’ Experience in claims-related.

Application Closing Date
Not Specified.

How to Apply
Interested and qualified candidates should:
Click here to apply online