About the Role
Dragnet Solutions is a dynamic Information Technology company specializing in the design, development, and implementation of innovative people screening and recruitment solutions. Since 2007, we have pioneered objective recruitment processes meeting international standards, serving as official e-recruitment partners to CIPM and Graduate Screening Technical Consultants to NECA. We are currently seeking a detail-oriented Managed Care Officer to manage our day-to-day interface with assigned HMO and retainership schemes, ensuring smooth enrollee care, timely reimbursements, and optimal operational efficiency in Nigeria.
Key Responsibilities- Verify enrollee eligibility and process pre-authorisation and referral requests efficiently within established scheme terms.
- Prepare, submit, track, and reconcile claims while following up promptly on rejections and outstanding payments.
- Liaise proactively with assigned scheme partners to resolve authorisations, queries, and disputes.
- Coordinate seamlessly with clinical teams to ensure patient care is delivered within scheme rules and properly documented.
- Respond promptly to enrollee enquiries and resolve complaints, escalating complex issues as needed.
- Maintain accurate managed-care records and generate comprehensive regular activity reports for management.
- Minimum of 4 years of relevant professional experience in managed care, HMO operations, health insurance, or hospital claims and billing.
- A relevant first degree or HND in health sciences, nursing, public health, business administration, or a related discipline.
- Mandatory completion of the NYSC scheme or possession of a valid exemption certificate.
- Working knowledge of HMO and retainership processes, medical authorisations, and claims management systems.
- Strong interpersonal skills with the ability to communicate effectively with clinical teams and external scheme partners.
- Relevant professional certifications in health insurance or managed care will be an added advantage.
- Competitive salary package commensurate with experience and industry standards.
- Opportunities for professional growth and career development within a leading organization.
- Comprehensive health insurance and wellness benefits for employees.
- A collaborative, innovative, and dynamic work environment.