About the Role
Dragnet Solutions is a dynamic Information Technology company specializing in innovative people screening solutions and objective recruitment processes that meet international standards. We are currently looking for a detail-oriented and proactive Managed Care Officer to join our team in Nigeria. In this role, you will manage the day-to-day interface with assigned HMO and retainership schemes, handling enrolee verification, authorizations, referrals, and claims to support smooth enrolee care and timely reimbursement.
Key Responsibilities- Verify enrolee eligibility and process pre-authorization and referral requests within scheme terms.
- Prepare, submit, track, and reconcile claims, following up promptly on rejections and outstanding payments.
- Liaise with assigned scheme partners on authorizations, queries, and disputes.
- Coordinate with clinical teams to ensure care is delivered within scheme rules and properly documented.
- Respond to enrolee enquiries and complaints, escalating issues as needed.
- Maintain accurate managed-care records and produce regular activity reporting.
- A relevant first degree or HND in health sciences, nursing, public health, business administration, or a related discipline.
- Completion of the mandatory NYSC scheme, or a valid exemption.
- Minimum of 4 years of relevant experience in managed care, HMO operations, health insurance, or hospital claims/billing.
- Strong working knowledge of HMO and retainership processes, authorizations, and claims.
- High attention to detail, excellent problem-solving abilities, and effective communication skills.
- Competitive salary package commensurate with experience.
- Opportunities for professional growth within a reputable organization.
- Health insurance and other corporate welfare benefits.
- Dynamic and collaborative work environment.