Requirements
What You’ll BringBachelor’s degree in Medicine (MBBS or equivalent)Minimum of 1 year clinical experience as a medical doctorStrong understanding of clinical procedures, terminology, and standards of careAbility to apply clinical knowledge to claims review and decision-makingStrong numerical and analytical skillsExperience working with data and processing information accuratelyClear written and verbal communication skillsProficiency in Microsoft Word and PowerPointNice to HaveExperience in claims processing or care approvals
Description
Associate, Claims OperationsEver wondered who makes sure healthcare claims are accurate, fair, and free from fraud? That’s the role we’re hiring for.About Reliance HealthWe're a healthcare technology company of 400+ people using technology to make healthcare affordable, accessible, and delightful in emerging markets. We operate across Nigeria, Egypt, Senegal, and Côte d'Ivoire, with 300,000 people depending on us for their healthcare. We're one of Time Magazine's World's Top Healthtech Companies (2025).We're a data-driven team that values ambitious thinking, simple communication, and working without micromanagement. We move fast, learn by doing, and our diverse team spans multiple nationalities and backgrounds.The RoleAs an Associate, Claims Operations, you’ll play a key role in ensuring healthcare claims are processed accurately and efficiently. You’ll help maintain fairness in the system by validating claims, identifying inconsistencies, and supporting timely reimbursements. If you’re detail-oriented and enjoy applying clinical knowledge to solve real-world problems, this role is for you.What You’ll DoReview, validate, and process healthcare claims in line with company policiesEnsure claims are accurately recorded and maintained in the systemInvestigate complex claims and make decisions based on clinical standards and internal guidelinesSupport timely payment of approved claims within defined service timelinesIdentify and decline fraudulent or suspicious claimsInvestigate cases of fraud, waste, and abuse, and escalate findings where necessaryCollaborate with provider management teams to resolve provider-related issuesShare claims updates and reconciliation details with healthcare providersProvide clinical input on complex care approvals when requiredSupport patient referral decisions in collaboration with the care team