Managed Care Officer - Warri

Managed Care Officer - Warri

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.

• 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.

• Nice to have

• Certification relevant to health insurance or managed care.

Experience

• 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.

Education

• 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.

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