Managed Care Officer - Kaduna

About the role

The Managed Care Officer coordinates day-to-day managed-care operations, ensuring efficient enrolee verification, service authorisation, claims processing and liaison with Health Maintenance Organisations (HMOs) and other healthcare scheme partners. The role supports patient satisfaction, claims recovery, revenue protection and compliance with service-level agreements. It is a full-time, on-site position in Kaduna.

Key responsibilities

• Verify enrolee eligibility, membership status and benefits before service delivery.
• Coordinate pre-authorisation requests, referrals and approvals with HMOs and other providers.
• Prepare, review and submit accurate claims documentation within agreed timelines, and follow up on outstanding claims and rejected claims with the Finance and Billing teams.
• Maintain working relationships with HMO representatives, corporate clients, enrolees and internal hospital departments, and respond to enquiries and complaints.
• Liaise with clinical teams so services are properly documented and consistent with approved benefits, and keep accurate records of enrolees, authorisations and claims.
• Monitor claims processing timelines, escalate delays, and prepare periodic reports on claims performance.
• Support new HMO and corporate retainership relationships and identify ways to improve enrolee experience and revenue collection.

Required profile

• Bachelor's degree or HND in Health Information Management, Nursing, Health Sciences, Business Administration, Public Health or a related discipline.
• Completion of the NYSC programme or a valid exemption, where applicable.
• Four to six years of relevant experience in managed care, HMO liaison, claims processing or health insurance operations.
• Desirable: experience in a hospital, diagnostic centre or HMO, and exposure to business development or client relationship management.
• Current professional registration and a valid practising licence where applicable; additional certification in health insurance or claims administration is an advantage.

Required skills

• Knowledge of HMO operations, claims administration, billing, pre-authorisation and revenue-cycle processes.
• Proficiency in Microsoft Office and healthcare information systems.
• Strong communication, analytical and problem-solving skills, attention to detail and confidentiality.

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.