Director of Claims and Tariff Management - Remote

Overview

Reliance Health’s mission is to make quality healthcare delightful, affordable, and accessible in emerging markets. From Nigeria, Egypt, to 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.

We are seeking a dynamic, data-driven, and experienced Director of Claims and Tariff Management to lead our efforts in optimizing claims processing and tariff management across our international markets. Join Reliance Health and be part of a team dedicated to transforming healthcare services in emerging markets. Apply now and contribute to our mission of making quality healthcare accessible and affordable for emerging markets.

Key Responsibilities:

• Cost Reduction and Fast Reimbursement Cycles: Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.
• Efficiency Improvement and Unpaid Claims Reduction: Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamlining workflows for faster adjudication.
• Automation and Rules-Based Claims Processing: Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.
• Prior Authorization Enhancement: Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.
• Cost Reduction and Fast Reimbursement Cycles: Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.
• Efficiency Improvement and Unpaid Claims Reduction: Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamlining workflows for faster adjudication.
• Automation and Rules-Based Claims Processing: Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.
• Prior Authorization Enhancement: Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.