Provider Manager (HMO)

Kaplo Africa | Ebonyi, Nigeria

Full-Time Posted 1 day ago 1 view

About the Role

Kaplo Africa is Africa's most innovative Human Resource and Business Support Solutions provider, delivering cutting-edge business advisory and human capital solutions. We are currently looking for a dynamic and results-driven Provider Manager to join our Provider Management and Operations department in Benin City, Edo State.

In this strategic role, you will be responsible for developing, managing, and maintaining a robust network of healthcare providers including hospitals, clinics, diagnostic centers, and pharmacies. Your efforts will ensure that our HMO enrollees receive accessible, quality, and cost-effective healthcare services while maintaining strong professional relationships and regulatory compliance across the region.

Key Responsibilities
  • Identify, recruit, and onboard new healthcare providers to expand the HMO network in Benin City and surrounding areas of Edo State.
  • Conduct rigorous facility assessments, due diligence visits, and coordinate credentialing activities.
  • Negotiate and manage favorable provider service agreements, tariffs, and service-level agreements.
  • Serve as the primary point of contact for healthcare providers, building enduring professional relationships and resolving disputes promptly.
  • Monitor provider performance against clinical standards, NHIA requirements, and internal HMO quality metrics.
  • Collaborate with Claims and Authorization teams to reduce claim rejections and streamline patient care pathways.
  • Prepare comprehensive network performance reports and provide strategic insights to management.
Qualifications
  • Bachelor's Degree in Medicine, Nursing, Health Sciences, Business Administration, or a related field.
  • Minimum of 8 years of relevant experience in healthcare, HMO operations, hospital administration, or provider relations.
  • Strong knowledge of the Nigerian healthcare system, NHIA guidelines, and healthcare contracting practices.
  • Familiarity with the healthcare landscape in Edo State and the South-South region.
  • Exceptional negotiation, relationship management, and problem-solving abilities.
  • Proficiency in Microsoft Office tools and healthcare management information systems.
  • Willingness to travel locally for facility audits and stakeholder meetings.
Benefits
  • Competitive salary and performance-based incentives.
  • Comprehensive health insurance coverage and wellness benefits.
  • Opportunities for professional growth within a leading African business solutions provider.
  • A collaborative, dynamic, and impact-driven work culture.

Skills

Provider Management HMO Operations Healthcare Administration Contract Negotiation Relationship Management NHIA Compliance Claims Support Quality Assurance
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