Medical Claims Processing Executive

We are seeking a detail-oriented, analytical Medical Claims Processing Executive to join our growing claims management team.

The Medical Claims Processing Executive will review, validate, and adjudicate medical claims to ensure accuracy, compliance with policy terms, and timely reimbursement. You will serve as a crucial bridge between healthcare providers, enrollees, and our company to ensure efficient service delivery.

Key Responsibilities

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Claims Adjudication: Review and process medical claims (inpatient/outpatient) in accordance with company policies and legal regulations.

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Documentation Verification: Audit provider bills, ensuring consistency with medical reports, prescriptions, and diagnostics.

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System Utilization: Accurately enter, update, and manage data within our electronic health records (EHR) and claims management software.

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Discrepancy Resolution: Research and resolve discrepancies in claims, including following up on outstanding information from hospitals or members.

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Fraud Detection: Identify and mitigate potential fraud and abuse in claims, implementing effective management practices.

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Customer Support: Handle inquiries from policyholders and providers regarding claim status with professionalism and empathy.

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KPI Management: Meet strict turnaround times (TAT) and quality standards for claim processing.

Requirements & Qualifications

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Education: Bachelor’s degree in Health Information Technology, Nursing, Pharmacy, or a related field.

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Experience: Experience in medical claims processing, medical billing, or TPA roles, medical bill audit, and coding knowledge of ICD-10.

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Technical Skills: Proficiency in MS Office (especially Excel), e-Claims Processing System, data analysis, visualization, and reporting.

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Industry Knowledge: Strong understanding of medical terminology, HMO operations, and insurance plans.

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Skills: Exceptional attention to detail, strong analytical thinking, and the ability to work under pressure.

How to Apply

Interested and qualified candidates should forward their CV and cover letter to hr@masslife.com.ng using the job title "Medical Claims Processing Executive" as the subject of the email.

Application Closing Date: March 20, 2026.

Only shortlisted candidates will be contacted.

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