Health / Medical

Quality Assurance Officer in a Health Insurance Company

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.


  • Confidence.
  • Excellent technical skills.
  • Good numericalskillsand an understanding of statistics.
  • Leadershipskills.
  • 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

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