About the Role
AXA Mansard is a leading global leader in insurance and asset management, committed to delivering exceptional financial and healthcare services across Nigeria. We are currently looking for a dynamic and detail-oriented Closed File Review Officer to join our growing team in Lagos. In this role, you will be responsible for conducting post-payment reviews of claims to identify anomalies, errors, or fraudulent activities that may have bypassed initial scrutiny, ensuring strict regulatory compliance, and driving optimal process improvements.
Key Responsibilities- Perform comprehensive retrospective audits and investigations on closed claims files to detect discrepancies or fraudulent patterns.
- Engage healthcare providers and manage escalations regarding billing anomalies and undue payment recoveries.
- Analyze claims data to generate detailed reports, trend analysis, and actionable insights for management.
- Collaborate closely with fraud, waste, and abuse (FWA) officers, nurses, and field auditors to streamline review processes.
- Contribute strategically to the enhancement of internal audit frameworks and capacity building within the team.
- Possession of an MBBS Degree from a reputable tertiary institution.
- Relevant certifications or strong practical knowledge in data analytics and health sector operations.
- Demonstrated clinical or claims review skills with a strong ability to interpret medical case notes, diagnoses, and provider billing.
- Exceptional attention to detail, analytical reasoning, and documentation skills with the ability to write clear, evidence-backed audit summaries.
- Deep understanding of medical networks, legal frameworks, and IT systems related to health insurance.
- Competitive salary and performance-based incentives.
- Comprehensive health insurance and wellness packages through AXA Mansard Health.
- Continuous professional development, training, and career advancement opportunities within a global organization.