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Managed Care Officer
About this role
Dragnet Nigeria seeks a Managed Care Officer in Lagos to manage the day-to-day interface with assigned HMO and retainership schemes, handling enrolee verification, authorisations, referrals and claims to support care and timely reimbursement. The role targets candidates with at least four years of relevant experience in managed care or health insurance and a relevant degree.
What you would do
- Verify enrolee eligibility.
- Process pre-authorisations.
- Process referrals.
- Manage claims.
- Liaise with scheme partners on authorisations, queries and disputes.
- Respond to enrolee enquiries and complaints.
What they are asking for
- Minimum four years of relevant experience in managed care/HMO operations, health insurance or healthcare administration.
- Experience in hospital claims/billing or health insurance operations.
- Working knowledge of HMO and retainership processes, authorisations and claims.
- Strong attention to detail and accuracy in claims and records.
- Ability to liaise effectively with scheme partners and clinical teams; good communication and problem-solving skills.
- Education: a relevant first degree or HND; NYSC completed or exempt; certification relevant to health insurance or managed care (nice to have).
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