Job Description:

  • Examine Healthcare Providers’ Claims using Tariff agreement to determine authenticity & payment.
  • Forward approved Claims to Team Lead for review and final approval.
  • Investigate complicated Claims and escalate to the Team lead, if necessary.
  • Investigate complicated claims by speaking to Enrollees and providers.
  • Update Providers’ dashboards and implement resolutions.
  • Decline fraudulent Healthcare Providers’ Claims, and state causative reasons.
  • Escalate fraudulent cases to the Committee of Doctors.


  • Must be a Registered Nurse/ Midwifery
  • Minimum of 2years experience as a Claims Assessor.
  • Excellent numeracy, analytical and problem-solving skills.
  • Strong ability to make a judgment on medical/ surgical cases in relation to enrollee’s benefits.
  • Ability to make a professional judgment on coverage and non-coverage of care requests per time.
  • Excellent interpersonal and communication skills.

By Systole

Dave is an accomplished medical writer with a passion for bridging the gap of knowledge between the healthcare system in Nigeria and medical professionals and the general public.

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