Quality Assurance and Case Manager at Reliance HMO

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Quality Assurance and Case Manager at Reliance HMO

  • Post Date:May 7, 2020
  • Views 210
0 Applications
Job Description

Quality Assurance and Case Manager at Reliance HMO

About Company:

We’re a health insurance company that acts like a technology company. We’re using software, data science and telemedicine to make health insurance more affordable, easier to access and more of a delightful experience.

Job Type:             Full Time

Qualification:      BA/BSc/HND

Experience:         1 year

Location:             Lagos

Job Field:             Medical / Healthcare

Salary Scale:         =N=70,000 +

Career Level:         Entry Level Career Position

Deadline for Application: 10th May, 2020

Expected Start Date: Q2, 2020


The Position

  • The ideal candidate will work with our Provider Relations, Customer Success, Claims and Underwriting teams and make sure that excellent and high quality service is provided to our clients across all provider networks while ensuring resolution of complicated claims and limiting fraud.
  • You will have major responsibility for managing the relationship between the company, our providers, and our enrolees.
  • You will facilitate the delivery of prompt services for clients as required on a case by case basis and maintain a healthy cost-quality balance as far as patient care is concerned.
  • You will track waste, fraud, and/or error from initial point of access to care by enrollees to final claims filing by the Provider
  • You’ll love this opportunity because…
    • You’ll have a clear career path
    • You’ll have a lot of independence in managing projects
    • We have a vibrant and active culture
    • Co-workers are a close-knit, intelligent, and motivated team

Key Responsibilities

  • Work with the Provider 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.
  • Investigate complicated claims by checking the case folder and speaking to the Enrolee 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
  • 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
  • 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.

Must Haves:

  • Minimum Experience: Minimum 1-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 enrolee’s plan.
  • Ability to make a professional judgment on coverage and non-coverage of care requests per time, based on the enrolee’s benefits table.
  • Exceptional problem solving and analytical skills
  • Excellent communication and presentation skills
  • Knowledge of, and sensitivity to, cultural and language differences.
  • Must be able to work as a team member and develop productive and cooperative working relationships with all members of the RHMO team
  • A demonstration of curiosity, love for learning, execution and speed.

Some Perks and Benefits

  • Employee-friendly working conditions
  • Generous health insurance package; including gym passes
  • Modern, cosy and collaborative workspace

To Apply

Interested and qualified? Go to Reliance HMO on docs.google.com to apply

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