Provider Manager (HMO)

AI summary

Kaplo Africa is hiring a Provider Manager (HMO) in Benin City, Edo State, to develop and manage a high-quality network of healthcare providers. The role focuses on provider relations, quality assurance, claims support, and network expansion for HMO enrollees. Full-time position requiring a bachelor's degree and at least 8 years of relevant healthcare or HMO experience.

• Full-time HMO provider management role based in Benin City, Edo State
• Focus on building and managing healthcare provider networks
• Requires bachelor's degree and minimum 8 years relevant experience
• Involves provider credentialing, compliance, and claims support
• Reports on network performance and provider utilization

Original source description

Kaplo is Africa's most innovative Human Resource & Business Support Solutions provider, serving clients with cutting-edge business advisory and human capital solutions across diverse sectors of the African economy. At Kaplo, we have proven expertise in business advisory and human resource capabilities targeted at productivity, profitability, susta... Provider Manager (HMO) Job Type Full Time Qualification BA/BSc/HND , Professional Certificate Experience: 8 years Location Lagos Job Field Medical / Healthcare Job Purpose The Provider Manager is responsible for developing, managing, and maintaining a high-quality network of healthcare providers (hospitals, clinics, diagnostic centers, pharmacies, and specialists) within Benin City and surrounding areas in Edo State. The role ensures that enrollees of the HMO receive accessible, quality, and cost-effective healthcare services while maintaining strong provider relationships, regulatory compliance, and operational efficiency. Key Responsibilities: Provider Network Development & Management: Identify, recruit, and onboard new healthcare providers to expand and strengthen the HMO’s provider network in Benin and Edo State. Conduct facility assessments and due diligence visits to evaluate capacity, quality standards, and suitability. Negotiate and manage provider service agreements, tariffs, and service-level agreements (SLAs). Maintain an up-to-date provider directory and ensure accurate mapping of facilities on the HMO’s systems. Relationship Management: Serve as the primary point of contact between the HMO and healthcare providers in the region. Build and sustain strong, professional relationships with hospital management, medical directors, and key clinical staff. Conduct regular provider engagement meetings, feedback sessions, and performance reviews. Resolve provider-related issues, complaints, and disputes promptly and professionally. Quality Assurance & Compliance: Monitor provider performance against agreed quality metrics, clinical standards, and HMO guidelines. Ensure all providers comply with National Health Insurance Authority (NHIA) requirements: and internal HMO policies. Coordinate provider credentialing, re-credentialing, and continuous quality improvement activities. Conduct periodic audits and facility inspections to ensure standards are maintained. Claims & Operational Support: Work closely with the Claims and Authorization teams to address claim-related queries and reduce rejections. Facilitate smooth authorization processes and ensure providers understand the HMO’s clinical guidelines and benefit packages. Support the resolution of enrollee complaints related to provider service delivery. Reporting & Analysis: Prepare regular reports on network performance, provider utilization, quality indicators, and expansion progress. Analyze provider data to identify gaps, opportunities, and areas for improvement. Provide insights and recommendations to management on network strategy in the Benin/Edo region. Other Duties: Support regional marketing and enrollee education: activities as required. Represent the HMO at relevant stakeholder meetings and industry events in the region. Perform any other related duties assigned by management. Key Performance Indicators (KPIs) Growth and retention of active providers in the network. Provider satisfaction and engagement levels. Reduction in provider-related complaints and claim disputes. Compliance rate of providers with quality and contractual standards. Timely submission of accurate network reports. Qualifications & Experience: Bachelor’s Degree in Medicine, Nursing, Health Sciences, Business Administration, or a related field. A postgraduate qualification or professional certification in Healthcare Management is an added advantage. Minimum of 8 years of relevant experience: in healthcare, HMO operations, hospital administration, or provider relations. Prior experience: working with Health Maintenance Organisations (HMOs) or in a managed care environment is highly preferred. Strong knowledge of the Nigerian healthcare system, NHIA guidelines, and provider contracting practices. Experience: managing relationships with hospitals and healthcare facilities in Edo State or the South-South region is an advantage. Skills & Competencies: Excellent relationship management and interpersonal skills. Strong negotiation and contract management abilities. Good analytical and problem-solving skills. High level of integrity and professionalism. Strong written and verbal communication skills. Ability to work independently with minimal supervision. Proficiency in Microsoft Office tools and healthcare information systems. Willingness to travel within Edo State and occasionally to other locations. Check how your CV aligns with this job Method of Application Interested and qualified candidates should send their CVs to: kaploafrica@gmail.com using “Provider Manager (HMO)” as the subject of the email. Build your CV for free. Download in different templates.