Sterling Health HMO is a National Health Insurance Agency (NHIA)-accredited Health Maintenance Organization (HMO) that has been providing 24/7/365 quality affordable healthcare service to the public and private sector nationally since 2007.
We are recruiting to fill the positions below:
Job Title: Call Centre Agent
Location: Lagos
Employment time: Full-time
Job Description
- Review and assess submitted healthcare claims for accuracy, completeness, and eligibility based on Sterling Health Insurance policies and guidelines.
- Verify patient eligibility and coverage details.
- Apply medical coding knowledge (e.g., ICD-10, CPT) to evaluate the appropriateness of services rendered.
- Identify and investigate discrepancies, errors, or potential fraudulent claims.
- Communicate with healthcare providers and enrollees to obtain necessary information or clarification regarding claims.
- Process claims accurately and within established turnaround times.
- Utilize the claims processing system effectively to input, review, and finalize claims.
- Maintain accurate and up-to-date records of all claims processed and actions taken.
- Adhere to all relevant regulatory requirements and internal policies related to claims processing.
- Stay updated on changes in medical coding, billing guidelines, and insurance regulations.
- Collaborate with other members of the Claims Department and other internal teams to resolve complex claims issues.
- Prepare reports on claims processing activities and trends as required.
- Assist in the development and implementation of claims processing procedures.
- Perform other claims-related duties as assigned.
Job Title: Claims / Vetting Officer
Location: Lagos
Employment time: Full-time
Job Description
- Review and assess submitted healthcare claims for accuracy, completeness, and eligibility based on Sterling Health Insurance policies and guidelines.
- Verify patient eligibility and coverage details.
- Apply medical coding knowledge (e.g., ICD-10, CPT) to evaluate the appropriateness of services rendered.
- Identify and investigate discrepancies, errors, or potential fraudulent claims.
- Communicate with healthcare providers and enrollees to obtain necessary information or clarification regarding claims.
- Process claims accurately and within established turnaround times.
- Utilize the claims processing system effectively to input, review, and finalize claims.
- Maintain accurate and up-to-date records of all claims processed and actions taken.
- Adhere to all relevant regulatory requirements and internal policies related to claims processing.
- Stay updated on changes in medical coding, billing guidelines, and insurance regulations.
- Collaborate with other members of the Claims Department and other internal teams to resolve complex claims issues.
- Prepare reports on claims processing activities and trends as required.
- Assist in the development and implementation of claims processing procedures.
- Perform other claims-related duties as assigned.
Application Closing Date
Not Specified.
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How to Apply
Interested and qualified candidates should forward their CV to: Sterlinghmo@gmail.com using the Job Title as the subject of the mail.
