[Vacancy]: Director of Claims and Tariff Management Needed at Reliance HMO

Job Description

Job Description

Reliance Health is seeking a dynamic, data-driven, and experienced Director of Claims and Tariff Management to lead our efforts in optimizing claims processing and tariff management across our international markets, with a primary focus on Egypt and Nigeria. Join Reliance Health and be part of a team dedicated to transforming healthcare services in emerging markets. Apply now and contribute to our mission of making quality healthcare accessible and affordable for emerging markets.

Key Responsibilities:

Cost Reduction and Fast Reimbursement Cycles:

  • Implement strategies to reduce costs and ensure rapid reimbursement cycles for claims across all active markets, enhancing overall operational efficiency and customer satisfaction.

Efficiency Improvement and Unpaid Claims Reduction:

  • Oversee initiatives to enhance the efficiency of claims and optimize team productivity and processing systems to reduce unpaid claims backlogs and streamline workflows for faster adjudication.

Automation and Rules-Based Claims Processing:

  • Lead the improvement of rules-based automated claims processing engines, leveraging technology to enhance accuracy, speed, and consistency in claims adjudication.

Prior Authorization Enhancement:

  • Enhance the accuracy and turnaround time for complex prior authorization requests, ensuring timely access to necessary healthcare services for our members.

Tariff Management and MER Improvement:

  • Drive improvement in turnaround time for tariff renegotiations and enhance Medical Expense Ratios (MER) through data-driven tariff and provider network tiering strategies.

Benefits Design and Operationalization:

  • Support the design and operationalization of benefits across our B2B and B2C offerings in multiple international markets, ensuring alignment with regulatory requirements and customer needs.

Fraud, Waste, and Abuse Mitigation:

  • Collaborate with provider and case management teams to identify and mitigate claims loss attributed to fraud, waste, and abuse, implementing proactive measures to safeguard against financial losses.


  • MBBS or Bachelor’s degree in Healthcare Administration, Business Management, with a preferred background of master’s level studies in data analysis or business administration
  • 8+ years of experience in claims management and tariff negotiation within the healthcare industry
  • Proven track record of implementing process improvements to enhance claims efficiency and reduce costs.
  • Strong background in data analysis and demonstrated ability to work with data to solve complex problems, utilizing advanced analytical tools and methodologies
  • Strong understanding of rules-based automated claims processing systems and prior authorization workflows.
  • Experience in tariff negotiation, provider network management, and benefits design across diverse markets.
  • Excellent leadership and communication skills, with the ability to collaborate effectively across cross-functional teams.
  • Analytical mindset with proficiency in data-driven decision-making and performance metrics evaluation.

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