Job Ref: HMS/QA-ABJ-09-17 Location: Abuja Summary
Coordination of health care provider and work site clinics, Manage relationship with Hospital and Clinics, Manage HMO quality initiatives, Coordinate disease management, health promotion and disease prevention of the organisation.
Work with marketing team to develop new products, Carry out provider mapping, Carry out provider accreditation with medical unit, Vetting of fee for service bills, and resolve grievances arising in the course of care, the medical/quality assurance reports and other duties that is assigned from time to time by the Executive Director.
Key Responsibilities Include the following:
Other duties may be assigned.
Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
Explain benefits, eligibility status, enrolment processing procedures and status of authorizations and referrals to callers.
Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls).
Process complaints, following established guidelines.
Maintain knowledge of National guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
Identify and escalate priority issues.
Requirements
Minimum of first Degree or its equivalent in Medicine or Health related field.
Certification in or professional membership of health, management or related bodies
Knowledge of statistical/epidemiological tools such as SPSS, Epiinfo. Ms power point etc
Minimum of 10 years experience post NYSC
Minimum of 5 years experience in relevant and related field
Attendance of related Courses/ workshops/seminars etc
HMO Experience is required
Knowledge of the operations of the National Health Insurance Scheme (NHIS)
Excellent customer relationship skills
Good communication/presentation skills (both oral and written)
Ability to communicate effectively in both oral and written English language
Must be a team player, able to build and maintain effective and collaborative sales and marketing network
Must be able to take responsibility and demonstrate high level of integrity in dealing with all stakeholders.
Required Skills:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and/or ability required.
Good Typing Skills
Attention to detail
Professional development through participation in continuing education and professional Organizations.
Good verbal and written communication skills
Conversant with the HMO processes and Maintenance
Must also be good in Coordination, Listening, Scheduling and Teamwork
Must possess good administrative skills
Superior problem solving skills
Ability to explain detailed instructions articulately and clearly
Ability to analyse Information promptly
Exceptional customer services skills
Proficient in relevant computer applications
Knowledge of customer service principles and practices
Knowledge of call centre telephony and technology
Relevant product knowledge.
Apploicants should send their application and Curriculum Vitae via Email, as an attachment to: hr@prepaidmedicareng.com And Via Post, addressed to: The Admin/HR Manager, Prepaid Medicare Services Limited (Head Office), Suite F6, Wing C, 3RD Floor, ABM Plaza (Opposite Utako Market), Plot Nos 23 Ekukinam Street, Off Obafemi Awolowo Way, Utako District, Abuja. Note: Use Job Title and Job Reference as subject of your email/letter.
Apply via :
hr@prepaidmedicareng.com
