Brasenwall Professional Consultants – Our client, one of the leading Health Insurance firms across the business locations, is recruiting to fill the position below:
Job Title: Medical Service Manager
Locations: Abuja, Port Harcourt – Rivers and Lagos
Contract Type: Full Time
Industry : Health Insurance (HMO)
Reports To: Head of Operations
Role Summary
- The Unit Lead, Medical Operations ensures that the unit meets its operational objectives as it relates to providers satisfaction, prompt payment of claims and medical utilization management.
- The Unit Lead, Medical Operation supervises the Team Lead, Claims and Team Lead, Provider/Case Management and also responsible and accountable to Management through the Head of Medical Operations
Specific Duities and Responsibilities
- Supervise and manage day-to-day itinerary of Case Managers
- Supervise and manage the day-to-day Case Management activities, utilization reviews, quality management activities and medical outreach or education programs
- Collate report of medical case reviews/audit, present findings, propose improvement plans and monitor strict execution of the improvement plans
- Collate report of utilization reviews, present findings, propose solution and monitor implementation of plans
- Collate report of accreditation and re-accreditation of providers and present findings for approval
- Co-ordinate and collate report of claims reconciliation with providers, present findings and resolutions and monitor execution of resolutions as well as collection of Letters of Non-Indebtedness (LONI)
- Co-ordinate the collation of regulatory report including monthly Fee-For-Service FFS) and Referral report,
- Quarterly Provider Sensitization and Itinerary report
- Co-ordinate the Pharmacy Benefit Program (Pharm-Assist) to manage medical cost from drugs (medications) without compromising client convenience
- Co-ordinate Medical Referral program to manage medical cost without compromising client convenience
- Co-ordinate the Claims Administration team to ensure prompt claims processing and payment to providers in line with the organization’s contract with the providers
- Manage high level relationships within every healthcare facility to ensure continued high quality service delivery
- Coordinate the prompt resolution of all escalated provider or claim grievance issues
Monitor and evaluate the day-to-day performance of the Case Managers and Claims Adjusters.
Requirements
- Experience Required: Minimum 4 years
- Education Level: MBBS
- Experience: Clinical Experience with HMO background will be an advantage
- Minimum of a first degree in Medicine
- Experience in the healthcare industry is an added advantage.
- Basic proficiency in the use of Microsoft Office tools
- Excellent communication skills.
Application Closing Date
Not Specified.
Method of Application
Interested and qualified candidates should send their Applications to: babalolaabbey@yahoo.com and copy: brasenwall@gmail.com using the Job Title as the subject of the email.
Note: Applicants should indicate their current remuneration in the body of the mail.
