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.