Managed Care Officer

Job title: Managed Care Officer

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...

Managed Care Officer

• Job Type Full Time, Onsite
• Qualification BA/BSc/HND
• Experience 4 years
• Location Edo
• City Benin
• Job Field Administration / Facilities, Medical / Healthcare

About the role

• To manage the day-to-day interface with assigned HMO and retainership schemes, handling enrolee verification, authorisations, referrals and claims to support smooth enrolee care and timely reimbursement.

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; experience in managed care, health insurance, HMO operations or hospital claims/billing; experience handling authorisations, claims and enrolee queries; experience working with clinical teams to deliver care within scheme rules.

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.