To manage the administrative, operational, and programme delivery functions of the NHIA/Public Sector Operations Unit, ensuring all payment processes, provider management activities, regulatory submissions, and programme reporting are executed accurately and on time.
Responsibilities
Payment & Claims Administration
Coordinate monthly NHIA capitation payments for FSSHIP to over 1,300 healthcare facilities
Coordinate monthly NHIA FFS (Fee for Service) payments to healthcare facilities
Manage end-to-end CEMONC claims processing, portal uploads, payment evidence documentation, and reimbursement letters to the Director General, NHIA
Oversee claims reconciliation exercises for CEMONC and FSSHIP programmes
Provider Management
Manage the onboarding and training of new NHIA FSSHIP facilities in coordination with the Provider Liaison Officer
Oversee adoption, execution, and retrieval of contracts with partner healthcare providers
Supervise the Provider Liaison Officer and CEMONC Claims Verifiers on day-to-day operations
Monitor facility performance and escalate issues to the Clinical Officer as required
Reporting & Regulatory Submissions
Prepare and submit weekly CEMONC programme reports to NHIA and all relevant stakeholders
Ensure FSSHIP and CEMONC records and data meet NHIA regulatory accuracy standards
Coordinate the organisation’s representation at NHIA and stakeholder events, logistics and documentation
Maintain a regulatory submissions calendar and ensure all deadlines are met
Contract Staff Coordination
Coordinate and supervise all contract staff within the unit, task allocation, quality review, and performance monitoring
Manage the scheduling, training, and retraining of CEMONC claims verifiers and FSSHIP claims officers
Escalate capacity issues and recommend contract staff adjustments to the Group Head
Other Public Sector Programs
Serve as clinical lead on public health programme design, quality metrics, and clinical governance frameworks within the McKinsey partnership workstream
Contribute clinical expertise to programme evaluation and outcome measurement
People & Team Management
Own programme reporting templates, stakeholder communications, and documentation for the McKinsey partnership workstream
Coordinate data submissions and milestone tracking for the programme
Education/ Professional Qualification
Bachelor’s degree in Health Sciences, Public Health, Business Administration, or related field
Experience
Experience in public health programme management
Experience in health insurance operations, HMO administration is an advantage
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