Risk Administration Associate at Reliance HMO

Job Summary

• This role is responsible for resolving clinical escalations raised by the Customer service team and resolving tickets raised to the Risk Division.

Job Description

• Review complex medical cases raised by Customer Service Representatives.
• Develop and Implement quality assurance best practices, as well as a robust performance measurement model for performance monitoring, and improvement.
• Drive down the incident rate of customer success agents requesting medical clarification from other sources/teams.
• Track clinical escalations, carry out root cause analysis and create DIY tools for Reliance Care Officers that help drive down the percentage of clinical escalations made.
• Support Product Team in new health insurance product development/product revision based on gathered claims vs benefits data.
• Resolve tickets raised to the Risk Division.

Job Experience

• Minimum of a First Degree in Medicine or Nursing
• 0 - 2 years post-NYSC experience.
• Exceptional problem solving and analytical skills.
• A demonstration of curiosity, love for learning, creativity, execution, and speed.
• Excellent communication and presentation skills.