COORDINATOR, MANAGED CARE SERVICES - ABUJA

COORDINATOR, MANAGED CARE SERVICES - ABUJA

Industry: Healthcare / Medical Services
Department: Managed Care / Patient Interface
Location: Abuja, Nigeria
Facility Type: Tier 1 Hospital
Grade: NS12–13
Reports To: Chief Medical Officer / Relevant Management Lead
Supervises: Managed Care Officers, Clinical Support and Customer Experience Staff
Experience: 6–8 years
Monthly Salary Range: ₦544,010 – ₦635,055

Job Purpose

The Coordinator, Managed Care Services will lead the hospital's managed-care operations, oversee relationships with Health Maintenance Organisations (HMOs) and retainership partners, and ensure efficient enrolee service delivery, claims management and authorisation processes. The role is responsible for balancing quality patient care, operational efficiency and commercial sustainability while ensuring compliance with scheme requirements and agreed service-level agreements.

Key Responsibilities

• Lead the hospital's managed-care operations and maintain effective relationships with HMOs, corporate retainership clients and other scheme partners.
• Oversee enrolee eligibility verification, pre-authorisation, referrals and care coordination in line with approved scheme benefits and contractual terms.
• Supervise claims preparation, documentation, submission, reconciliation and follow-up to minimise rejections, deductions and payment delays.
• Monitor service-level agreements and coordinate the resolution of claims disputes, service concerns and contractual issues with scheme partners.
• Collaborate with clinical teams to ensure patient care is appropriate, evidence-based, cost-effective and consistent with approved scheme provisions.
• Supervise, coach and develop managed-care, clinical support and customer experience staff to achieve operational targets.
• Monitor managed-care revenue, claims performance, outstanding receivables and service delivery indicators, providing regular reports and recommendations to management.
• Champion a positive enrolee experience by ensuring timely service, effective complaint resolution and improved patient retention.
• Identify operational gaps and implement process improvements to strengthen claims accuracy, authorisation turnaround and revenue collection.
• Ensure accurate records, appropriate documentation and compliance with hospital policies, contractual obligations and applicable healthcare regulations.
• Work closely with the Finance and Billing teams to reconcile claims, track outstanding payments and improve revenue-cycle performance.
• Support the development and review of managed-care policies, operational procedures and performance standards.

Key Performance Indicators (KPIs)

Performance will be assessed based on:

• Claims rejection and deduction rates, including improvements in claims accuracy.
• Average claims submission and processing turnaround time.
• Pre-authorisation and referral processing within agreed service-level timelines.
• Managed-care revenue collected against amounts billed.
• Ageing and reduction of outstanding claims and receivables.
• Compliance with service-level agreements and claims dispute-resolution timelines.
• Enrolee satisfaction, complaint-resolution rate and quality of service delivery.
• Team productivity, staff development and achievement of departmental targets.

Academic Qualifications

Essential

• A relevant first degree in Health Sciences, Nursing, Public Health, Business Administration, Healthcare Management or a related discipline.
• Completion of the National Youth Service Corps (NYSC) programme or a valid exemption, where applicable.

Desirable

• A postgraduate qualification or professional certification in Managed Care, Health Insurance, Health Administration, Healthcare Management or a related field.

Professional Registration, Licence and Certification

Essential

• Candidates who are registered health professionals must hold current registration and a valid practising licence from the relevant regulatory body, where applicable.

Desirable

• Professional certification in health insurance, managed care, claims administration or healthcare management.

Required Experience

Essential

• A minimum of eight years of relevant experience in managed care, HMO liaison, health insurance or healthcare administration, including supervisory responsibilities.
• Substantial experience managing HMO operations, health insurance schemes, hospital claims or healthcare revenue-cycle processes.
• Demonstrable experience coordinating claims, pre-authorisations, referrals, reconciliations and relationships with scheme partners.
• Experience supervising staff, monitoring service performance and implementing operational improvements.

Role-Specific Experience

• Experience coordinating clinical and commercial functions within a healthcare environment.
• Experience managing enrolee concerns, claims disputes and service delivery in line with contractual requirements.

Desirable

• Experience working in a multi-specialty hospital, corporate hospital network or an HMO-facing healthcare organisation.

Knowledge, Skills and Competencies

• Strong knowledge of managed-care operations, HMO processes, retainership arrangements and health insurance administration.
• Sound understanding of claims management, pre-authorisation, referrals, billing and revenue-cycle management.
• Ability to balance clinical requirements, patient experience and commercial considerations.
• Strong leadership, team supervision, coaching and performance-management skills.
• Excellent communication, negotiation, stakeholder-management and problem-solving abilities.
• Strong analytical skills, with the ability to interpret claims data, revenue reports and operational performance indicators.
• Working knowledge of managed-care systems, claims platforms and healthcare reporting tools.
• High attention to detail, integrity, confidentiality and commitment to quality patient service.

Working Relationships

Internal Stakeholders

• Chief Medical Officer and Hospital Management
• Clinical Departments and Medical Teams
• Finance and Billing Department
• Quality Assurance Team
• Customer Experience and Patient Support Teams

External Stakeholders

• Health Maintenance Organisations (HMOs)
• Corporate Retainership and Health Insurance Partners
• Enrolees and Patients
• Relevant Health Insurance Bodies and Other Scheme Partners

Ideal Candidate Profile

The ideal candidate is an experienced healthcare administration or managed-care professional with strong leadership, analytical and stakeholder-management capabilities. The candidate must be able to manage HMO relationships, improve claims recovery, strengthen operational controls and deliver a positive enrolee experience while supporting the hospital's financial and service-delivery objectives.

How to Apply

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

Only candidates who meet the stated requirements will be shortlisted.