Job title: Freelance Case Management (Ikot Epkene)
Company: Reliance Health
Job description: Reliance Health’s mission is to make quality healthcare delightful, affordable, and accessible in emerging markets. From Nigeria, Egypt, Senegal and beyond, we offer comprehensive health plans tailored to both employers’ and employees’ needs through an integrated approach that includes telemedicine, affordable health insurance, and a combination of partner and proprietary healthcare facilities.By leveraging advanced technology, we are transforming the healthcare landscape, making it more efficient and accessible for everyone.The Case Management Associate is responsible for analyzing and reporting fraud, waste, and abuse data, managing the escalation of emergency cases, conducting mortality investigations, overseeing general case management and care coordination activities, managing at-risk cases, and monitoring ICU admissions of enrollees receiving healthcare services from providers within the Reliance HMO Providers network.Responsibilities
- Analyze claims data, billing records, and other relevant information to identify patterns, anomalies, and potential cases of fraud, waste, and abuse
- Utilize data analytics tools and techniques to identify trends, outliers, and potentially fraudulent activities
- Collaborate with medical professionals, forensic experts, and internal teams to gather relevant information and conduct thorough investigations
- Ensure compliance with applicable laws, regulations, and company policies related to fraud, waste, and abuse investigations, emergency
- Case management, mortality investigations, general case management, managing at-risk cases, and ICU admissions
Requirements
- Bachelor’s degree in medicine, nursing, or related disciplines
- Knowledge of healthcare operations, fraud prevention, and regulatory compliance.
- Experience in conducting fraud, waste, and abuse investigations is preferred.
- Knowledge of emergency management protocols and procedures.
- Familiarity with mortality review processes and quality improvement initiatives.
- Knowledge of legal and regulatory requirements related to fraud, waste, and abuse investigations, emergency care, and case management.
- Professional certifications in fraud examination, case management, or related fields (e.g., Certified Fraud Examiner, Certified Case Manager) are advantageous.
Benefits
- At Reliance Health, we prioritize our people and their well-being. Our benefits package is designed to support your success, growth, and happiness. Here’s what you’ll enjoy:
- Competitive Salary and Benefits
We offer a salary that’s benchmarked against the best in the industry, ensuring your expertise and impact are fully rewarded. * Premium Health InsuranceComprehensive health coverage for you and your family, because your well-being comes first. * Unlimited LeaveTake the time you need when you need it—no limits, no questions. * Meaningful ImpactPlay a key role in transforming customer experiences and shaping healthcare innovation. * Collaborative Work CultureJoin a supportive, inclusive, and team-focused environment that celebrates diversity. * Growth OpportunitiesAccess tools, mentorship, and resources to elevate your skills and career. * Learning & Development AllowanceWe provide an allowance to support your ongoing professional growth and skill enhancement. * This is more than a job—it’s a chance to grow, thrive, and make a real difference. At Reliance Health, your journey matters.
Expected salary:
Location: Ikot Ekpene, Akwa Ibom State
Job date: Wed, 16 Apr 2025 22:52:35 GMT