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: Senior Claims Associate

Location: Lagos
Employment type: Full Time
Reports to: Team Lead, Claims and Analytics
Expected Start Date: Q2 2020

The Candidate

• The ideal candidate for this role is someone with a start-up mentality who is ready to work hard and push the limits in ensuring claims vetting and management process is a success.
• The Senior Claims Associate will be responsible for vetting all claims submitted by our Providers to ensure they are error and fraud free
• They will manage claims payment and be involved in the resolution of medical cases requiring special attention.

Key Responsibilities

• Examine Healthcare Providers’ Claims using the Tariff agreement to determine authenticity and payment.
• Decline fraudulent Healthcare Providers’ Claims, and state causative reasons.
• Forward approved Claims to Team Lead for review and final approval.
• Investigate complicated Claims and escalate to Team lead, if necessary.
• 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.
• Relate with the Customer success team to manage concession requests.
• Relate with technology and design team on any update on the processes regarding the claims of Healthcare Providers.
• Relate with Provider Relations Service unit for tariff agreement.

Minimum Qualifications

• Minimum of a Bachelor of Medicine and Bachelor of Surgery (MBBS).
• Relevant work experience in a similar role is an added advantage
• Excellent Numeracy, Analytical and Problem-solving skills.
• Strong ability to make judgement on medical/ surgical cases in relation to benefits listed on enrollee’s benefits.
• Ability to make professional judgement on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.

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

Job Title: Data Scientist

Location: Lagos
Employment Type: Full Time
Reports To: Team Lead, Claims and Analytics
Expected Start Date: Q2 2020

Key Responsibilities

• Identifying, analyzing, and interpreting claims, provider and enrollee data trends or patterns based on past or historical data
• Collate and interpret data, analyzing results from varied sources
• Generates periodic reports (daily, weekly and monthly) such as Claims frequency reports, Provider Quality Assurance reports, Enrollee / Client usage reports etc. as may be required by the management team.
• Monitor Claims team performance relative to set targets by tracking MLRs and reporting to the Business
• Research and develop statistical learning models for claims data analysis
• Collaborate with product management and engineering departments to understand company needs and devise possible solutions
• Keep up-to-date with latest technology trends that has direct impact on claims management and claims data analytics
• Implement new statistical or other mathematical methodologies as needed for specific models or analysis
• Optimize joint development efforts through appropriate database use and project design
• Selecting features, building and optimizing classifiers using machine learning techniques
• Data mining using state-of-the-art methods
• Extending company’s data with third party sources of information when needed
• Enhancing data collection procedures to include information that is relevant for building analytic systems
• Processing, cleansing, and verifying the integrity of data used for analysis
• Doing ad-hoc analysis and presenting results in a clear manner
• Creating automated anomaly detection systems and constant tracking of its performance
• Perform any other duty as may be communicated by Management Team.

Minimum Qualifications

• Bachelor’s Degree in any of the following disciplines: Engineering, Accounting, Economics, Banking & Finance or other numerate discipline
• 2-3 years relevant work experience, from related sector/ organization with demonstrable understanding of data analytics.
• Relevant work experience in a similar role is an added advantage
• Excellent Numeracy, Analytical and Problem-solving skills.
• Good working knowledge of Power BI, Microsoft Office suite: Word, Excel and PowerPoint.

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