MANAGED CARE OFFICER - KADUNA

MANAGED CARE OFFICER - KADUNA

Industry: Healthcare / Medical Services
Department: Business Development & Managed Care
Location: Kaduna, Nigeria
Employment Type: Full-Time
Work Arrangement: On-Site
Experience: 4–6 Years
Monthly Salary Range: ₦495,919 – ₦544,010

Job Purpose

The Managed Care Officer will coordinate day-to-day managed-care operations, ensuring efficient enrolee verification, service authorisation, claims processing and liaison with Health Maintenance Organisations (HMOs) and other healthcare scheme partners. The role will support patient satisfaction, effective claims recovery, revenue protection and compliance with agreed service-level agreements.

Key Responsibilities

• Verify enrolee eligibility, membership status and benefits before service delivery in line with applicable scheme requirements.
• Coordinate pre-authorisation requests, referrals and approvals with HMOs and other healthcare scheme providers.
• Prepare, review and submit accurate claims documentation within agreed timelines.
• Follow up on submitted claims, outstanding payments, rejected claims and deductions, working with the Finance and Billing teams to resolve discrepancies.
• Maintain effective working relationships with HMO representatives, corporate clients, enrolees and internal hospital departments.
• Respond to enquiries and complaints relating to eligibility, benefits, authorisations and managed-care services.
• Liaise with clinical teams to ensure services provided are appropriately documented and consistent with approved scheme benefits.
• Maintain accurate records of enrolees, authorisations, claims, correspondence and outstanding issues.
• Monitor claims processing timelines and escalate unresolved issues or service delays to the relevant supervisor.
• Support the development of new HMO and corporate retainership relationships in collaboration with the Business Development team.
• Identify opportunities to improve enrolee experience, claims accuracy, service turnaround and revenue collection.
• Prepare periodic reports on claims submissions, rejections, outstanding balances, authorisations and other managed-care performance indicators.
• Ensure compliance with hospital policies, contractual obligations, confidentiality requirements and applicable healthcare regulations.

Key Performance Indicators (KPIs)

• Accuracy and timeliness of claims preparation and submission.
• Reduction in avoidable claims rejections and deductions.
• Turnaround time for enrolee verification and pre-authorisation.
• Timely follow-up and resolution of outstanding claims.
• Enrolee satisfaction and complaint-resolution rates.
• Accuracy and completeness of managed-care documentation.
• Compliance with HMO service-level agreements.
• Contribution to improved claims recovery and managed-care revenue performance.

Academic Qualifications

Essential

• Bachelor's degree or HND in Health Information Management, Nursing, Health Sciences, Business Administration, Public Health or a related discipline.
• Completion of the National Youth Service Corps (NYSC) programme or a valid exemption, where applicable.

Desirable

• Professional training or certification in Managed Care, Health Insurance, Healthcare Administration or Revenue Cycle Management.

Professional Registration and Certification

• Current professional registration and a valid practising licence are required where applicable to the candidate's regulated professional qualification.
• Additional certification in health insurance, claims administration or managed-care operations will be an advantage.

Required Experience

• Four to six years of relevant experience in managed care, HMO liaison, healthcare administration, claims processing or health insurance operations.
• Practical experience with enrolee verification, pre-authorisation, claims submission and reconciliation.
• Experience liaising with HMOs, corporate healthcare clients and clinical or administrative teams.
• Demonstrable ability to manage claims documentation, resolve discrepancies and follow up on outstanding payments.

Desirable

• Experience working in a hospital, diagnostic centre, HMO or other healthcare service environment.
• Exposure to business development, client relationship management or corporate retainership services.

Knowledge, Skills and Competencies

• Good understanding of HMO operations, managed-care processes and health insurance benefits.
• Knowledge of claims administration, billing, pre-authorisation and revenue-cycle processes.
• Strong communication, customer service and relationship-management skills.
• Good analytical, documentation and problem-solving abilities.
• Proficiency in Microsoft Office applications and healthcare information systems.
• Strong attention to detail and ability to manage multiple tasks within deadlines.
• Professionalism, confidentiality, integrity and a patient-centred approach.

Working Relationships

Internal Stakeholders

• Business Development and Managed Care Team
• Clinical and Medical Services
• Finance and Billing
• Health Records
• Customer Experience and Patient Support

External Stakeholders

• Health Maintenance Organisations (HMOs)
• Corporate Retainership Clients
• Enrolees and Patients
• Other Healthcare Scheme Partners

Ideal Candidate Profile

The ideal candidate is organised, detail-oriented and customer-focused, with practical experience in managed-care operations and HMO relationship management. The candidate should be able to coordinate claims and authorisations efficiently, resolve service issues professionally and contribute to improved patient experience and revenue recovery.

How to Apply

Interested and qualified candidates should send their updated CV to hiring@mysigma.io, using Managed Care Officer – Kaduna as the email subject.

Only candidates who meet the stated requirements will be shortlisted.