Medical Doctor at Novo Health Africa

About the Role

We are seeking a highly skilled and experienced Medical Doctor to join our dynamic team. The ideal candidate will have strong HMO industry experience with proven expertise in Provider Management, Billings, and Claims.

This role requires a detail-oriented professional who can ensure quality service delivery, effective provider engagement, and efficient management of claims and billing processes.

Key Responsibilities

• Manage and maintain strong relationships with healthcare providers to ensure quality service delivery
• Oversee provider onboarding, contracting, performance review, and compliance with HMO standards
• Review and evaluate medical claims, ensuring accuracy, validity, and alignment with clinical standards and tariff agreements
• Coordinate the billing and claims process, ensuring timely adjudication and resolution
• Monitor utilization trends, identify fraudulent or abusive claims, and recommend corrective actions
• Provide medical support for Pre-Authorizations, Case Management, and Utilization Review
• Ensure adherence to regulatory guidelines, clinical best practices, and internal policies
• Support the development and implementation of provider engagement strategies and service improvement initiatives
• Prepare periodic reports and analytics to support decision-making

Requirements

• MBBS or MBBCh from a recognized institution (with valid practicing license)
• Minimum of 5 years post-NYSC experience, with at least 3 years working in an HMO setting
• Strong knowledge of HMO operations, NHIA guidelines, provider management, billing protocols, and claims adjudication
• Excellent analytical, communication, and negotiation skills
• High level of integrity, attention to detail, and ability to work in a fast-paced environment
• Proficiency in MS Office and basic health management software