Managed Care Officer (kaduna) At Dragnet Nigeria

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.

Experience

Minimum of 4 years of relevant experience in managed care/HMO operations, health insurance or healthcare administration.

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.