Head of Claims at Pivotage Consulting

Pivotage Consulting - Our Client, an organization that deals in Health Maintenance Organization (HMO) is currently seeking to grow its team by hiring qualified candidates in the capacity below:Job Title: Head of ClaimsRef Id: MHT/1121/HOCLocation: Lagos, NigeriaType: Full Time Career: Mid/Level ExpertJob PurposeThis position is responsible for claims processing and administration. It also includes analysis of utilization and claims patterns to identify areas of improvement and process changes that will result in medical cost control.Job ResponsibilitiesCoordinating the management of all Claims processes from submission, initial review, sorting and tracking, pre-processing, adjudication, review, scheduling for payment and then reconciliation and sign off on paid claims.Ensuring accurate processing of all claims following proper enrollee verification, enrollees eligibility, PA confirmation, and according to contracted fee schedule with provider.Ensuring timely processing of claims and appeals on FIFO bases to ensure payment within 30 days of receipt of claims at any of our office.Ensuring proper filing and maintenance of claims documents and make sure the information is readily available.Conducting a review of processed claims for errors and ensure accuracy of processed claims and preparation of claim schedules for paymentResponsible for the supervision of the staff in claims unit including training and team building.Providing regular reports on claims status, receipt, processed and payment.Monitoring and evaluation of utilization patterns byAnalyzing  of preauthorization reports to identify regional and provider specific trends and propose process changes and policies for effective utilization managementAnalyzing of claims reports to identify regional and provider specific trends and propose process changes and policies for effective utilization managementProviding regular reports on claims status, trends and utilization patterns. 

Apply at https://ngcareers.com/job/2019-02/head-of-claims-at-pivotage-consulting-592/