HMO Claims Officer Job at Emel Hospital

Emel Hospital is a purpose-built 30 bed hospital situated on a piece of land specially approved for its purpose by the Federal Housing Authority. Emel Hospital was established in 1988 by Dr. Olufemi Mobolaji-Lawal, a consultant pediatrician. Dr. Mobolaji-Lawal trained as a doctor at the University College Hospital, Ibadan and as a pediatrician in the United Kingdom. Prior to setting Emel Hospital, he worked for some time as a consultant pediatrician at Ikeja General Hospital (now Lagos State University Teaching Hospital), Lagos. He is the board chairman and his wife, Dr. (Mrs) Margaret Mobolaji-Lawal is a non-executive director.

The hospital was declared open on the 9th of December 1988 by the then Honorable Minister of Health of Nigeria, Prof. Olikoye Ransome-Kuti. It is the first private hospital in Lagos, Nigeria to be designated “Baby Friendly Hospital” by the Federal Ministry of Health in 1993. We are a well-recognized and foremost pediatric referral centre in Amuwo Odofin area and its environs, as well as providing general medical care and specialist services in obstetrics and gynaecology, internal medicine and various surgical specialities. Our facility is fully computerized and staffed with professionals to deliver excellent primary medical and specialist's services. We actively promote excellence with a view to ensuring complete client satisfaction at all times.

We are recruiting to fill the position below:

Job Position: HMO Claims Officer
Job Location: Festac, Lagos
Employment Type: Full-time

Description 

• Examine bills and claims from using the agreed Tariff to ensure authenticity.
• Ensure bills are vetted before sending them to HMOs
• Ensure diagnosis matches with treatment
• Escalate complicated fraudulent claims to the management.
• Forward approved Claims to Clinical Director for review and final approval.
• Request for both payment advice and schedule from HMOs
• Ensure Authorization codes are received as appropriate for all secondary healthcare
• Ensure the lists of registered enrollees from HMOs are updated or ensure the enrollee's status is verified before treatment.
• Investigate suspicious claims through Enrollee contact, case folder checks and other approved protocols
• Participate in the resolution of medical claims cases requiring rigorous negotiations

Requirements

• Interested candidates should possess an HND with 3 - 5 years of work experience.

Method of Application
Interested and qualified candidates should send their CV and Scanned copies of their credentials to: hr@emelhospital.org using the Job Position as the subject of the