Sigma Consulting Group – Our client, a Health Insurance company in Nigeria requires the services of a suitably qualified candidates to fill the position below:
Job Title: Quality Assurance Officer
Location: Lagos, Nigeria
Employment Type: Full-time
- The ideal candidate must be a Professional Doctor, who would work with our Provider Relations Team, Customer Success Teams, Claims and Underwriting teams and make sure that excellent and high-quality service is provided to clients across all provider networks while ensuring resolution of complicated claims and limiting fraud.
- He /She will have major responsibility for managing the relationship between the company, our providers, and our enrollees.
- The ideal Candidate would be demanded to track waste, fraud, and/or error from initial point of access to care by enrollees to final claims filing by the Provider.
- Work with the Provider’s Team to ensure the minimum standards for quality are met before sign up.
- Inspect and evaluate hospitals to ensure compliance with basic standards.
- Carry out physical inspection at the assigned provider’s office using the checklist.
- Carry out regular hospital quality checks.
- Develop and implement survey tools for patient feedback and communicating data results to Providers to ensure continuous improvement.
- Visit patients in the hospital to ensure they are getting medically necessary care, quality care and that the care is being delivered as efficiently and economically as possible.
- Anticipates the patient’s future health care needs and tries to put in place mechanisms to meet those needs as efficiently as possible
- Ensure efficiency and cost effectiveness of medical services provided to clients
- Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
- Escalate fraudulent cases to the Committee of Doctors.
- Update Providers’ dashboard, and implement resolutions.
- Recommend changes to improve the efficiencies in the systems and process of the Provider Relations as well as the Claims team.
- Recognize and fix areas of weakness in the system to limit potential for fraud
- Takes initiative to present ideas and suggestions to leadership
- Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops.
- Perform all other duties as assigned.
- Minimum 2-year experience in Clinical Practice or Quality assurance role
- Must be a Medical Doctor
- Strong ability to make judgment on medical/ surgical cases in relation to benefits listed on enrollee’s plan.
- Ability to make a professional judgment on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.
- Exceptional problem solving and analytical skills
- Excellent communication and presentation skills
- Knowledge of, and sensitivity to, cultural and language differences.
- A demonstration of curiosity, love for learning, execution and speed.
- Minimum of Bachelor’s Degree.
- Excellent technical skills.
- Good numericalskillsand an understanding of statistics.
- Planning and organization skills.
- Communication and interpersonal skills.
- Problem-solving skills.
- Teamworking skills.
Deadline: 4th September, 2020.
How to Apply
Interested and qualified candidates should:
Click here to apply online