MetroHealth HMO Limited is a Health Maintenance Organization which has been established with the objective of becoming the HMO of choice for corporate entities and all subscribing enrolees, who want good quality healthcare accessed through a technology enabled platform that will enhance the whole customer experience. The platform has been configured towards administering efficient patient centred services.
Our focus is on quality and service delivery, ensuring prompt, personalized and seamless quality healthcare support services to our clients, both young, middle age and old.
Technology drives our operations as it undergirds our operational efficiencies and provides access to timely data which is beneficial to both providers and enrolees. Several technology portals are made available through controlled access for enrolees to view and manage their health data, and for providers to submit and receive payment for services delivered.MetroHealth HMO Ltd is seeking a qualified and experienced Claims Executive to join our dynamic team.
Job Summary
The Claims Executive will be responsible for claims processing, vetting, analysis, reconciliation, and ensuring timely and accurate claims administration in line with organizational standards.
Requirements
Must be a Registered Nurse (RN) with relevant professional certification
Minimum of 3 years’ relevant experience in the HMO/Health Insurance space
Strong knowledge of medical claims processing and tariff interpretation
Good understanding of NHIA guidelines and healthcare claims management
Excellent analytical and reconciliation skills
High level of accuracy and attention to detail
Proficiency in Microsoft Office and claims management systems
Strong communication and interpersonal skills
Key Responsibilities
Vet and process provider claims accurately and promptly
Review claims for compliance with benefit plans and tariffs
Liaise with healthcare providers on claims-related issues
Conduct claims reconciliation and reporting
Identify discrepancies and recommend corrective actions
Ensure adherence to internal policies and regulatory requirements