Job Title: MEDICAL CLAIMS REVIEW OFFICER
Employment Type: Full-Time
Location: Alausa, Lagos State
Salary: ₦200,000 Monthly Net
Industry: HMO
Qualification:  Bachelor of Nursing Science(BNSC) and NYSC only
Age: 35 (maximum)
Experience: 2-5 years

Job Summary
We seek a Medical Claims Review Officer to verify and process hospital claims, ensure accuracy, and manage cost efficiency. Candidates must have a BNSC, completed NYSC, and be under 35 years old. Shift flexibility required.

Responsibilities
• Manage hospital claims (quality check, verification and adjudication)
• Processing of providers’ claims in line with set procedures and policies, ensuring that claims are documented accurately.
• Ensures processed claims are resolved with a prompt and effective outcome.
• Responsible for the reconciliation of Claims with service providers
• Provide data needed to take key decisions i.e., Provider re-categorization.
• Proactively manage claims to ensure settlement at the optimum cost while delivering financial savings through cost saving initiatives.
• Utilizes analytical skills to identify problems and proffer solutions within the unit.
• Works closely with Team Lead to identify and follow through with fictitious/suspicious claims.
• Resolves issues with minimal external input and escalates where necessary.

Work Schedule/ Shift details 
•  8:00am - 5:00pm, 9:00am - 6:00pm, 5:00pm - 8:00am (will periodically include Night/ Weekend / Public Holiday Duties)