Closed File Review Officer

About this role

AXA Mansard in Lagos seeks a Closed File Review Officer to perform post-payment reviews of insurance claims, identifying anomalies, errors or potential fraud that may have bypassed initial scrutiny. The role requires MBBS qualifications with data analytics knowledge and health-sector or claims review experience, and involves collaboration with FWA officers, nurses and field auditors.

What you would do

• Conduct post-payment reviews of paid claims to identify anomalies, errors or potential fraud
• Ensure compliance and recover undue payments where applicable
• Engage providers and escalate issues to relevant stakeholders
• Analyse claims data and prepare evidence-based reports and trend insights
• Oversee the claims review team and support capacity building
• Contribute to the development of frameworks and strategic improvements in claims processes

What they are asking for

• MBBS degree from a reputable tertiary institution
• Knowledge or qualification in data analytics
• Experience in clinical or claims review
• Ability to interpret medical case notes, diagnoses, procedures and provider billing
• Health sector experience (e.g. with HMOs, hospitals, claims teams or provider audits)
• Strong documentation skills with ability to write clear, evidence-backed audit findings

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