Reliance Health uses Technology to Make Healthcare Accessible and Affordable. Through an integrated approach that includes affordable health insurance, telemedicine, and a combination of partner and proprietary healthcare facilities, Reliance Health offers innovative healthcare solutions that meet the needs of emerging markets.

We are recruiting to fill the position below:

Job Title: Case Management Associate (Freelance)

Location: Lagos
Employment Type: Full Time

Description

• 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

• Work alongside & learn from best-in-class talent
• Join a market leader within the Insurance space
• Attractive Salary & benefits
• Fantastic work culture
• Work and learn from some of the best in the industry
• Great work-life balance.

Application Closing Date
Not Specified.