Reliance Health (www.reliancehmo.com) is a healthcare company using technology to make healthcare more affordable and accessible. Through an integrated approach that includes affordable health insurance, telemedicine and a combination of partner and proprietary healthcare facilities, Reliance Health offers innovative healthcare solutions that meet the needs of emerging markets.
We are also backed by some of the world’s most prominent investors including Partech, Y Combinator and Tencent.
- Job Position: Claims Examiner
- Job Location: Gbagada, Lagos
- The Contract Claims Examiner role is for a renewable 3-month period. The role holder will be responsible for vetting claims submitted by our Providers to ensure they are error and fraud-free.
- You are a team player – able to work across different stakeholders, communicate expectations openly and clearly, and welcome constructive feedback.
- Examine Healthcare Providers’ Claims using Tariff agreement to determine authenticity & payment.
- Forward approved Claims to Team Lead for review and final approval.
- Investigate complicated Claims and escalate to Team lead, if necessary.
- Investigate complicated claims by speaking to Enrollees and providers.
- Update Providers’ dashboard and implement resolutions.
- Decline fraudulent Healthcare Providers’ Claims, and state causative reasons.
- Escalate fraudulent cases to the Committee of Doctors.
- Minimum of a first degree in a Medical or Healthcare related field (e.g. Medicine, Dentistry, Nursing, Medical Laboratory Sciences, etc)
- Excellent numeracy, analytical and problem-solving skills.
- Strong ability to make a judgment on medical/ surgical cases in relation to enrollee’s benefits.
- Ability to make a professional judgment on coverage and non-coverage of care requests per time.
- Excellent interpersonal and communication skills.
7th February, 2021.
How to Apply
Interested and qualified candidates should:
Click here to apply online