Coordinator, Managed Care Services

About the role

A Tier 1 hospital in Abuja is looking for a Coordinator, Managed Care Services (grade NS12-13) to lead its managed-care operations. The role oversees relationships with Health Maintenance Organisations (HMOs) and retainer partners, and ensures efficient enrollee service, claims management and authorisation. It balances quality patient care, operational efficiency and commercial sustainability while meeting scheme requirements and service-level agreements.

Key responsibilities

• Lead managed-care operations and maintain relationships with HMOs, corporate retainership clients and scheme partners.
• Oversee enrollee eligibility, pre-authorisation, referrals and care coordination in line with scheme benefits and contracts.
• Supervise claims preparation, documentation, submission, reconciliation and follow-up to reduce rejections, deductions and payment delays.
• Monitor service-level agreements and resolve claims disputes and service concerns with partners.
• Work with clinical teams so care is evidence-based, cost-effective and consistent with approved schemes.
• Supervise, coach and develop managed-care, clinical support and customer experience staff.
• Monitor managed-care revenue, claims performance, outstanding receivables and service indicators, reporting regularly to management.
• Improve claims accuracy, authorisation turnaround and revenue collection through process improvements.
• Ensure accurate records, compliance with policies and regulations, and work with Finance and Billing to reconcile claims and track outstanding payments.
• Support the development and review of managed-care policies, procedures and performance standards.

Required profile

• First degree in Health Sciences, Nursing, Public Health, Business Administration, Healthcare Management or a related field; NYSC completion or exemption where applicable.
• At least eight years of relevant experience in managed care, HMO liaison, health insurance or healthcare administration, including supervisory duties.
• Substantial experience managing HMO operations, hospital claims or revenue-cycle processes, and supervising staff.
• Desirable: postgraduate qualification or professional certification in managed care, health insurance or health administration; experience in a multi-specialty hospital, hospital network or HMO-facing organisation.
• Registered health professionals must hold current registration and a valid practising licence.

Required skills

• Knowledge of managed-care operations, HMO processes, retainership arrangements and health insurance administration.
• Understanding of claims management, pre-authorisation, referrals, billing and revenue-cycle management.
• Working knowledge of managed-care systems, claims platforms and healthcare reporting tools.
• Strong leadership, communication, negotiation, stakeholder management and analytical skills.

Performance is measured on claims rejection and deduction rates, turnaround times, revenue collected, outstanding receivables, SLA compliance, enrolee satisfaction and staff productivity. Candidates apply by sending an updated CV to the employer, with the job title in the subject line; only those meeting the requirements will be shortlisted.