Job Vacancies at RelianceHMO

RelianceHMO is a Y Combinator 2017 Winter Batch company backed by leading Silicon Valley Venture Capitalists that uses software, data science, and telemedicine to make health insurance delightful, affordable and easier to access. Leveraging effective product management and growth strategies, we have successfully positioned ourselves as a competitive player in the Nigerian Health Insurance Industry. In addition to the quality of our services, we are extremely proud of our dynamic work environment where you can be whoever you want to be. We are a team of bubbly, hardworking individuals whose culture and core values allow us complement each other and collaborate towards common goals.

We are recruiting to fill the position below:

Job Title: Quality Assurance and Case Manager

Location: Lagos Employment type: Full Time Expected Start Date: Q1, 2020

The Position

You will have major responsibility for managing the relationship between the company, our providers, and our enrollees. You will facilitate the delivery of prompt services for clients as required on a case by case basis and maintain a healthy cost-quality balance as far as patient care is concerned
You will track waste, fraud, and/or error from initial point of access to care by enrollees to final claims filing by the Provider
The ideal candidate will work with our Provider Relations, Customer Success, Claims and Underwriting teams and make sure that excellent and high quality service is provided to our clients across all provider networks while ensuring resolution of complicated claims and limiting fraud

You’ll love this opportunity because…

...you'll have a clear career path
...you'll have a lot of independence in managing projects
…we have a vibrant and active culture
…co-workers are a close-knit, intelligent, and motivated team

Key Responsibilities

Visit patients in the hospital to ensure they are getting medically necessary care, quality care and that the care is being delivered as efficiently and economically as possible.
Anticipates the patient’s future health care needs and tries to put in place mechanisms to meet those needs as efficiently as possible
Ensure efficiency and cost effectiveness of medical services provided to clients
Takes initiative to present ideas and suggestions to leadership
Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops.
Work with the Provider Team to ensure the minimum standards for quality are met before sign up.
Inspect and evaluate hospitals to ensure compliance with basic standards.
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.
Recommend changes to improve the efficiencies in the systems and process of the Provider Relations as well as the Claims team.
Recognize and fix areas of weakness in the system to limit potential for fraud
Carry out regular hospital quality checks.
Develop and implement survey tools for patient feedback and communicating data results to Providers to ensure continuous improvement.
Perform all other duties as assigned.

Requirements Must Haves:

Exceptional problem solving and analytical skills
Excellent communication and presentation skills
knowledge of, and sensitivity to, cultural and language differences.
Must be able to work as a team member and develop productive and cooperative working relationships with all members of the RHMO team
Must be a Medical Doctor with at least 2 years of experience in similar role.
Strong ability to make judgment on medical / surgical cases in relation to benefits listed on enrollee’s plan.
Ability to make professional judgment on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.
A demonstration of curiosity, love for learning, execution and speed.

Some Perks and Benefits

Daily meals
Employee-friendly working conditions
Generous health insurance package; including gym passes
Modern, cosy and collaborative workspace.

How to Apply Interested and qualified candidates should: Click here to apply

Job Title: Customer Success Quality Specialist Location: Lagos

The Position

The ideal candidate is a Medical Doctor who will work with our Customer Success team and make sure that excellent and high quality service is provided to our clients across all communication channels.
Your major responsibility will be to clarify medical enquiries from Providers and Enrollees as well as train the Customer Success team on the description of medical terms so as to ensure that all queries coming into the customer success department are resolved fully within the team.

Key Responsibilities

Accomplish quality assurance objectives by orienting, training and coaching customer success team on medical terms
Develop and Implement quality assurance best practices, as well as a robust performance measurement model which will provide a basis for performance monitoring, and management.
Drive down incident rate of customer success agents requesting medical clarification from other sources / teams.
Enhance customer relationship in order to meet organizational and operational objectives
Carry out periodic coaching sessions to provide both qualitative and quantitative feedback based on the employee’s performance
Ensuring clients (corporate customers, retails customers, distribution partners and providers) have a seamless encounter with using our service.
Obtain client information by answering telephone calls; interviewing clients; verifying information.
Respond to all Enrollee and Provider inquiries and handle any complaints
Take telephone calls on behalf of Reliance HMO in order to fulfil customer requirements.
Have the most up to date information on all plans of Reliance HMO and be able to help customers in a quick and friendly fashion.
Maintain communication equipment by reporting any faults promptly
Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops.
Perform all other duties as assigned.

Qualifications

Must be a Medical Doctor
Willingness to work shifts across Monday to Sunday
Strong ability to make judgment on medical / surgical cases in relation to benefits listed on enrollee’s plan.
Ability to make professional judgment on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.
Excellent communication and presentation skills
Must be able to transfer knowledge to other team members

Benefits You’ll love this opportunity because: