Claims Executive – Healthcare Insurance

About the role

MetroHealth HMO Limited is seeking a qualified Claims Executive to join its Lagos team. The role focuses on processing, vetting, and reconciling healthcare provider claims while ensuring compliance with internal policies and regulatory standards.

Key responsibilities

• Vet and process provider claims accurately and promptly.
• Review claims for compliance with benefit plans, tariffs, and NHIA guidelines.
• Liaise with healthcare providers to resolve claims‑related issues.
• Conduct claims reconciliation and generate regular reports.
• Identify discrepancies, recommend corrective actions, and ensure adherence to regulatory requirements.

Required profile

• Registered Nurse (RN) with relevant professional certification.
• Minimum of 3 years experience in the HMO or health‑insurance sector.
• Strong knowledge of medical claims processing, tariff interpretation, and NHIA guidelines.
• Excellent analytical, reconciliation, and attention‑to‑detail abilities.
• Effective communication and interpersonal skills.

Required skills

• Microsoft Office
• Claims management systems