About the Role
Dragnet Solutions is looking for a detail-oriented Managed Care/Marketing Officer to join our team in Mosimi. In this role, you will serve as the primary interface for assigned HMO and retainership schemes, ensuring seamless healthcare administration, enrolee verification, and efficient claims processing to support our organizational goals.
Key Responsibilities- Verify enrolee eligibility and process pre-authorisation and referral requests in compliance with scheme terms.
- Prepare, submit, track, and reconcile medical claims while following up promptly on rejections and outstanding payments.
- Liaise effectively with assigned scheme partners regarding authorisations, queries, and operational disputes.
- Coordinate closely with clinical teams to guarantee care delivery aligns with scheme rules and is properly documented.
- Provide exceptional support by responding to enrolee enquiries and resolving complaints in a timely manner.
- Maintain accurate managed-care records and generate comprehensive periodic activity reports.
- Possession of a relevant first degree or HND in health sciences, nursing, public health, business administration, or a related discipline.
- Successful completion of the mandatory NYSC program or possession of a valid exemption certificate.
- Minimum of 4 years of proven professional experience in managed care, HMO operations, health insurance, or healthcare administration.
- Thorough working knowledge of HMO and retainership processes, authorisations, and medical claims management.
- Strong communication, problem-solving, and interpersonal skills with high attention to detail.
- Competitive salary package commensurate with industry standards.
- Opportunities for professional growth and career advancement within a leading technology and screening firm.
- Comprehensive health and wellness benefits.
- A collaborative and dynamic work environment driven by excellence and integrity.