Fresh Jobs at Reliance HMO

  • We’re a health insurance company that acts like a technology company. We’re using software, data science and telemedicine to make health insurance more affordable, easier to access and more of a delightful experience

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    Data Scientist

    • Job Type Full Time
    • Qualification BA/BSc/HND
    • Experience 2 – 3 years
    • Location Lagos
    • Job Field Research / Data Analysis&nbsp

    Reports To: Team Lead, Claims and Analytics
    Expected Start Date: Q2 2020

    Key Responsibilities

    • Identifying, analyzing, and interpreting claims, provider and enrollee data trends or patterns based on past or historical data
    • Collate and interpret data, analyzing results from varied sources
    • Generates periodic reports (daily, weekly and monthly) such as Claims frequency reports, Provider Quality Assurance reports, Enrollee / Client usage reports etc. as may be required by the management team.
    • Monitor Claims team performance relative to set targets by tracking MLRs and reporting to the Business
    • Research and develop statistical learning models for claims data analysis
    • Collaborate with product management and engineering departments to understand company needs and devise possible solutions
    • Keep up-to-date with latest technology trends that has direct impact on claims management and claims data analytics
    • Implement new statistical or other mathematical methodologies as needed for specific models or analysis
    • Optimize joint development efforts through appropriate database use and project design
    • Selecting features, building and optimizing classifiers using machine learning techniques
    • Data mining using state-of-the-art methods
    • Extending company’s data with third party sources of information when needed
    • Enhancing data collection procedures to include information that is relevant for building analytic systems
    • Processing, cleansing, and verifying the integrity of data used for analysis
    • Doing ad-hoc analysis and presenting results in a clear manner
    • Creating automated anomaly detection systems and constant tracking of its performance
    • Perform any other duty as may be communicated by Management Team.

    Minimum Qualifications

    • Bachelor’s Degree in any of the following disciplines: Engineering, Accounting, Economics, Banking & Finance or other numerate discipline
    • 2-3 years relevant work experience, from related sector/ organization with demonstrable understanding of data analytics.
    • Relevant work experience in a similar role is an added advantage
    • Excellent Numeracy, Analytical and Problem-solving skills.
    • Good working knowledge of Power BI, Microsoft Office suite: Word, Excel and PowerPoint.

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    Senior Claims Associate

    • Job Type Full Time
    • Qualification BA/BSc/HND
    • Experience
    • Location Lagos
    • Job Field Medical / Healthcare&nbsp

    Reports to: Team Lead, Claims and Analytics
    Expected Start Date: Q2 2020

    The Candidate

    • The ideal candidate for this role is someone with a start-up mentality who is ready to work hard and push the limits in ensuring claims vetting and management process is a success.
    • The Senior Claims Associate will be responsible for vetting all claims submitted by our Providers to ensure they are error and fraud free
    • They will manage claims payment and be involved in the resolution of medical cases requiring special attention.

    Key Responsibilities

    • Examine Healthcare Providers’ Claims using the Tariff agreement to determine authenticity and payment.
    • Decline fraudulent Healthcare Providers’ Claims, and state causative reasons.
    • Forward approved Claims to Team Lead for review and final approval.
    • Investigate complicated Claims and escalate to Team lead, if necessary.
    • Carry out physical inspection at the assigned provider’s office using the checklist.
    • Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
    • Escalate fraudulent cases to the Committee of Doctors.
    • Update Providers’ dashboard, and implement resolutions.
    • Relate with the Customer success team to manage concession requests.
    • Relate with technology and design team on any update on the processes regarding the claims of Healthcare Providers.
    • Relate with Provider Relations Service unit for tariff agreement.

    Minimum Qualifications

    • Minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS).
    • Relevant work experience in a similar role is an added advantage
    • Excellent Numeracy, Analytical and Problem-solving skills.
    • Strong ability to make judgement on medical/ surgical cases in relation to benefits listed on enrollee’s benefits.
    • Ability to make professional judgement on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.

    Method of Application

    Use the link(s) below to apply on company website.

     

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