HMO ASSISTANT

manages the bridge between the health insurance organization, healthcare providers (hospitals, clinics, pharmacies), and corporate or individual enrollees.Provider Network & Relationship Management

• Contract Negotiation: Negotiate service level agreements (SLAs), tariff plans, and pricing terms with hospitals, clinics, and pharmacies.
• Provider Onboarding & Training: Guide new healthcare facilities through credentialing, orientation, and education on HMO policies, rules, and workflows.jobberman.zohorecruit.com +1
• Compliance & SLA Monitoring: Track provider performance to ensure adherence to agreed quality standards, turnaround times, and patient care guidelines.Noor Health +1
• Issue & Dispute Resolution: Address complaints and inquiries from healthcare providers regarding capitation, fee-for-service structures, or patient treatment delivery.Jobberman +1

Enrollee & Client Support

• Client & Enrollee Liaison: Serve as the main point of contact for corporate HR departments, individual subscribers, and enrollees to ensure smooth service delivery.
• Benefits & Authorization Guidance: Explain plan benefits, coverage eligibility, referral paths, and pre-authorization requirements to enrollees and provider front-desk teams.
• Escalated Complaint Handling: Resolve service delays, authorization bottlenecks, and denied care or billing escalations swiftly.YouTube +1

Claims, Billing & Administrative Operations

• Claims & Billing Coordination: Oversee the accurate preparation, submission, and tracking of medical claims and reconciliation of accounts with providers or client companies.
• Authorization Tracking: Ensure proper tracking and documentation of authorization codes for hospital visits, surgeries, and specialized procedures.
• Data & CRM Management: Maintain up-to-date client and provider records in CRM systems, tracking satisfaction metrics, retention rates, and account activity.
• Reporting: Generate periodic reports on utilization trends, claims expenditure, provider performance, and client satisfaction for HMO upper management

Pay: ₦70,000.00 - ₦80,000.00 per hour

Work Location: In person