3 Aca jobs in Nigeria

JOB TITLE: Health Insurance Contract & Claims Manager
JOB LOCATION:
Abuja (FCT)

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Job Details

• The Health Insurance Contract and Claims Manager will oversee the administration and management of AMCE's insurance contracts, ensuring compliance with regulatory requirements and organizational policies.
• The role holder will also manage the claims process, ensuring timely and equitable resolution of claims, and providing expert guidance on insurance-related matters.

Responsibilities
Insurance Management:

• Accurately interpret insurance policies to determine coverage, exclusions, and limitations and apply relevant policy provisions to specific claims and underwriting scenarios.
• Oversee the entire claims process, from initial notification to final settlement, investigate claims to determine liability, coverage, and potential losses.
• Negotiate settlements with claimants or their representatives, manage the claims handling process, including documentation, communication, and payment and identify and mitigate potential fraud and abuse.
• Monitor, assess and evaluate risks associated with insurance policies and claims and implement risk management strategies to minimize losses.
• Ensure compliance with all relevant insurance regulations, including licensing, reporting, and solvency requirements.
• Manage reinsurance programs, including treaty negotiations, placements, and claims recoveries and analyze reinsurance treaties to optimize coverage and minimize costs.

Claims Handling

• Receive and acknowledge insurance claims, investigate claims to determine coverage, liability, potential losses and collect and analyze relevant documentation, such as medical records, police reports, and property damage assessments.
• Assess the extent of damages and losses incurred by the insured, determine the appropriate coverage and policy limits, and calculate the estimated cost of repairs or replacements.
• Negotiate settlements with claimants or their representatives, process and authorize claim payments and ensure timely and accurate claim settlements.
• Identify and investigate potential fraud or abuse in insurance claims, collaborate with law enforcement and other relevant authorities as needed and implement measures to prevent and detect fraud.
• Communicate effectively with claimants, explaining the claims process and providing updates on the status of their claims.

Contract Negotiation

• Review and analyze insurance contracts, endorsements, and reinsurance treaties to ensure compliance with legal and regulatory requirements, identify potential risks and opportunities within contracts and develop strategies to mitigate risks and maximize benefits.
• Negotiate terms and conditions with clients, brokers, and reinsurers, balance the interests of AMCE with those of the counterparty and seek to optimize contract terms in terms of coverage, pricing, and conditions.
• Draft and finalize insurance contracts, endorsements, and other legal documents, ensure that contracts are clear, concise, legally enforceable, and obtain necessary approvals and signatures for contract execution.
• Monitor contract performance to ensure compliance with terms and conditions, address any contract disputes or claims and update contracts as needed to reflect changing circumstances.
• Manage relationships with vendors and suppliers, negotiate contracts with vendors and suppliers and monitor vendor performance and ensure compliance with contract terms.

Risk Assessment

• Identify potential risks to the insurance business, such as operational risks, financial risks, and reputational risks and assess the likelihood and potential impact of identified risks.
• Collaborate with other departments to identify and address risk exposures, implement risk management frameworks and policies to govern risk management activities and review risk management procedures to ensure their effectiveness.
• Manage the claims process, including investigation, assessment, and settlement. Identify and mitigate potential fraud and abuse in claims and implement effective claims management practices to minimize losses and expedite claim settlements.
• Develop and implement reinsurance programs to transfer risk and protect the AMCE's financial stability, negotiate reinsurance treaties with reinsurers and monitor reinsurance recoveries and ensure timely payments.
• Stay updated on regulatory changes and industry best practices and ensure compliance with regulatory requirements, including solvency, capital adequacy, and reporting standards.

Qualifications

• Bachelor's degree in insurance, business administration, finance, risk management, or a related field.
• Master's degree in business administration (MBA) with a specialization in finance, risk management, or insurance is an added advantage.
• Chartered Insurance Institute qualification
• Minimum of 7 years of experience in the insurance industry, with a strong focus on contract management, claims handling, and risk management.
• Experience in leading teams and managing complex projects.
• A deep understanding of the insurance industry, including products, regulations, and market trends.

Knowledge Requirements

• Understanding of the Insurance Claims Administration
• Understanding the operation of the healthcare sector insurance.
• Understanding of risk management issues.
• Knowledge of insurance principles and practice.

Skill Requirements

• Analytical Skills
• Problem-Solving Skills
• Negotiation Skills
• Communication Skills
• Attention to Detail
• Time Management

Personal Abilities

• Professional attitude towards work
• Shares the AMCE's vision.
• Proactive and organized.
• Has personal and professional credibility and commands the respect of colleagues and peers.
• Supportive and approachable and capable of inspiring confidence in staff members
• Ability to adapt accordingly.
• High levels of honesty and integrity

How To Apply
To apply for the ongoingDeloitte Job recruitment, visit the
APPLICATION PORTAL
to submit your application

JOB TITLE: Health Insurance Contract and Claims Officer
JOB LOCATION:
Abuja (FCT)

*JOB DETAILS: *
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• The role is responsible for managing and administering contracts and claims related to HMO (Health Maintenance Organization) and international health insurance schemes.
• This role requires a strong understanding of healthcare contracts, claims processing procedures, and regulatory requirements, particularly those concerning HMOs and international insurance providers.
• The officer will act as a key liaison between the organization, HMOs, international insurers, and patients, ensuring smooth and efficient processing of claims and adherence to contractual obligations.

*Core Responsibilities *
HMO Contract Management:

• Negotiate and manage contracts with HMOs, ensuring favorable terms and conditions for the organization.
• Analyze HMO contracts to identify potential risks and opportunities.
• Monitor HMO performance and compliance with contractual obligations.
• Develop and maintain strong relationships with HMO representatives

International Health Insurance Contract Management:

• Evaluate and select international health insurance providers based on organizational needs and patient demographics.
• Negotiate contracts with international insurers, ensuring comprehensive coverage and competitive pricing.
• Stay abreast of international healthcare regulations and insurance practices.

Claims Processing And Management:

• Oversee the processing of HMO and international health insurance claims, ensuring accuracy, timeliness, and compliance with relevant procedures.
• Investigate and resolve claim discrepancies and disputes.
• Monitor claim trends and identify areas for improvement in claims processing efficiency.

Relationship Management:

• Build and maintain strong relationships with HMOs, international insurers, patients, and internal stakeholders.
• Provide exceptional customer service to patients and address their inquiries regarding claims and coverage.

Compliance And Reporting:

• Ensure compliance with all applicable healthcare regulations, insurance laws, and organizational policies.
• Generate and analyze reports on HMO and international health insurance claims, identifying key performance indicators and trends.

Cost Containment:

• Implement strategies to manage and reduce healthcare costs related to HMO and international insurance claims.
• Negotiate favorable rates with providers and insurers.
• Educate patients on cost-effective healthcare options.

*Educational Requirements *

• Bachelor's degree in Insurance, Risk Management, Finance, or a related field.
• Master's degree in Insurance, Risk Management, or a related field is an added advantage.

Professional Requirements:

• Relevant certification (such as PMP, ACA & ACCA) is an added advantage.

Experience Requirements:

• 1 – 4 years of experience in insurance administration, claims management, or risk management.
• Experience in the healthcare sector is preferred.

Core Responsibilities:
Knowledge Requirements:

• In-depth knowledge of insurance principles, contracts, and regulations.
• Understanding of risk management frameworks and methodologies.
• Knowledge of healthcare industry trends and regulations.
• Familiarity with relevant legal and regulatory requirements.
• Understanding of financial accounting principles.

Skills Requirements:

• Proficiency in using relevant software applications (e.g., spreadsheets, databases, claims management software.
• Understanding of risk management methodologies and techniques.
• Knowledge of insurance principles, contracts, and regulations.
• Proficiency in data analysis and reporting
• Strong analytical and problem-solving skills

Personal Abilities:

• Professional attitude toward work
• Shares the AMCE's vision.
• Proactive and organized.
• Has personal and professional credibility and commands the respect of colleagues and peers.
• Supportive and approachable.
• Ability to adapt accordingly.
• High levels of honesty and integrity.

*HOW TO APPLY
To apply for the ongoing Deloitte Job recruitment, visit the
APPLICATION PORTAL *
to submit your application

Deadline: February 21, 2025