MetroHealth HMO Ltd is seeking a qualified and experienced Claims Executive to join our dynamic team.
Job Summary
The Claims Executive will be responsible for claims processing, vetting, analysis, reconciliation, and ensuring timely and accurate claims administration in line with organizational standards.
Requirements
Must be a Registered Nurse (RN) with relevant professional certification
Minimum of 3 years' relevant experience in the HMO/Health Insurance space
Strong knowledge of medical claims processing and tariff interpretation
Good understanding of NHIA guidelines and healthcare claims management
Excellent analytical and reconciliation skills
High level of accuracy and attention to detail
Proficiency in Microsoft Office and claims management systems
Strong communication and interpersonal skills
Key Responsibilities
Vet and process provider claims accurately and promptly
Review claims for compliance with benefit plans and tariffs
Liaise with healthcare providers on claims-related issues
Conduct claims reconciliation and reporting
Identify discrepancies and recommend corrective actions
Ensure adherence to internal policies and regulatory requirements