Managed Care / Marketing Officer

Managed Care / Marketing Officer - Mosimi

Dragnet Solutions is a dynamic Information Technology company that specializes in the design, development and implementation of innovative people screening solutions. Since our incorporation in 2007, we have been at the forefront of creating and recreating objective recruitment and application management processes to meet international standards. As official...

About the role

• The Managed Care/Marketing Officer is responsible for managing the day-to-day interface with assigned HMO and retainership schemes.
• The role involves handling enrolee verification, authorizations, referrals, and claims processing to ensure smooth enrolee care and timely reimbursements.

Responsibilities

• Verify enrolee eligibility and process pre-authorisation and referral requests within scheme terms.
• Prepare, submit, track and reconcile claims, and follow up promptly on rejections and outstanding payments.
• Liaise with assigned scheme partners on authorisations, queries and disputes.
• Coordinate with clinical teams to ensure care is delivered within scheme rules and properly documented.
• Respond to enrolee enquiries and complaints, escalating as needed.
• Maintain accurate managed-care records and produce regular activity reporting.

Requirements

• A relevant first degree or HND (e.g. health sciences, nursing, public health, business administration, or a related discipline).
• Completion of NYSC, or a valid exemption where applicable.
• Minimum of 4 years of relevant experience in managed care/HMO operations, health insurance or healthcare administration.

Required skills

• Working knowledge of HMO and retainership processes, authorisations and claims.
• High attention to detail and accuracy in claims and records.
• Ability to liaise effectively with scheme partners and clinical teams.
• Effective communication and problem-solving.
• Competent use of relevant claims/records systems.