Experience

• 

  HCI HEALTHCARE HMO (formerly HEALTHCARE INTERNATIONAL (HMO 004)

  • Nigeria

  • Claims and Provider Relationship Manager

    • Jan 2019 - Present
    • Nigeria

• 

  HMO

  • KWARA

  • QUALITY ASSURANCE EXECUTIVE

    • Jun 2016 - Present
    • KWARA

     Responsible for ensuring, clinical process are conducted in accordance with guidelines and regulations, develop, perform and manages quality assurance activities. Preside over HCF evaluation. Ensure that all processes contributing to the accreditation of HCFs are conducted properly as per organisation’ policy Troubleshoot activities and liaise with quality assurance manager Manage and maintain database for the quality system  Marketing of all company’s insurance plan Prepare and assist in annual report and quality trending reports which are daily and trending Preside over improvement programs with HCF’s and Enrolees  Evaluate quality events, incidents, queries and complaints and address them with the help of quality assurance manager. Keep up-to-date with all related quality legislation and compliance issues Compile and prepare materials for submission to regulatory agencies. Document internal regulatory processes Ensure regulatory rules are communicated through corporate policies and procedures Utilize guidance documents, international standards, or consensus standard and interpret for guidance Ensure HCF,s evaluation are conducted as per organisation’s policy Communicate any risks compliance noted from these activities to superior management, Sensitisation of enrolee, HCFs, and organisations on Health insurance packages and other health promotional activities And any other activities as assigned by the management.

• 

  OLUWATENIOLA FARM

  • 14,HARMONY AVENUE OKE OSE ILORIN KWARA STATE

  • TECHNICAL ADVISER

    • Mar 2013 - Present
    • 14,HARMONY AVENUE OKE OSE ILORIN KWARA STATE

    IT IS ALL ABOUT FISH PROCESSING,PACKAGING AND DISTRIBUTION TO THE CUSTOMERS ACROSS THE NATION.

• 

  Premium Health Limited

  • FIELD NURSING OFFICER

    • Sep 2009 - Present

    Description Key Responsibilities:• Gather attendance data from Providers and send to Head Office• providing pertinent information to promote customer satisfaction and account retention• Validate and verify claims through retrospective reviews and placing calls to enrollees on claims list.• Authenticate authorization already given for immediate spot checks/visits for verification and confirmation purpose to detect real cases from false cases• Job Conduct concurrent review of admissions and surgeries.• From utilization data, conduct random checks on case notes for quality care assessment and to identify false attendances/treatment/diagnosis/investigations. • Collate encounter data for the purpose of utilization rates/reports. • Reduce cases of care denial by intervening on behalf of the Company to resolve issues and/or complaints which may lead to care denial to our enrollees by Providers.• Coordinate correspondences between Premium Health and the Provider• Prepare and send reports on particular cases of surgeries, deliveries or other procedures encountered daily on the field and document such properly. • Exceed Customer's expectations, good interpersonal rapour with the clients, and more health education to all those on chronic drugs at every delivery, weather home or office, making myself available in the office and making most of them to know importance of keeping appointment time.• Take charge of evacuation of Enrollees for Secondary care to Gold Cross Hospital for further management in peculiar primary cases as well as well as secondary cases.• Facilitate enrollee access to care by fast tracking enrollee hospital files to reduce waiting period at the Hospitals.• Facilitate Organizational growth, vetting of claims properly, turn down secondary cases that are in genuine• All other tasks assigned from time to time

• 

  LUBCON OIL HEAD OFFICE

  • ILORIN ,KWARA STATE

  • Nursing Officer

    • Sep 2005 - Sep 2009
    • ILORIN ,KWARA STATE