Director of Claims and Tariff Management

Reliance Healths mission is to make quality healthcare delightful, affordable, and accessible in emerging markets. From Nigeria, Egypt, to Senegal and beyond, we offer comprehensive health plans tailored to both employers and employees needs through an integrated approach that includes telemedicine, affordable health insurance, and a combination of partner and proprietary healthcare facilities.

By leveraging advanced technology, we are transforming the healthcare landscape, making it more efficient and accessible for everyone.

We are 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. 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 streamlining 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.
• 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 streamlining 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.

Requirements

• MBBS or Bachelors degree in Healthcare Administration, Business Management, with a preferred background of masters 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.

Benefits

At Reliance Health, we prioritize our people and their well-being. Our benefits package is designed to support your success, growth, and happiness. Heres what youll enjoy:

• Hybrid, Flexible Environment Experience the best of both worlds with our hybrid setup—work from home when you need focus, and connect with a vibrant, collaborative team in the office.
• Competitive Salary and Benefits We offer a salary thats benchmarked against the best in the industry, ensuring your expertise and impact are fully rewarded.
• Premium Health Insurance Comprehensive health coverage for you and your family, because your well-being comes first.
• Unlimited Leave Take the time you need when you need it—no limits, no questions.
• Meaningful Impact Play a key role in transforming customer experiences and shaping healthcare innovation.
• Collaborative Work Culture Join a supportive, inclusive, and team-focused environment that celebrates diversity.
• Growth Opportunities Access tools, mentorship, and resources to elevate your skills and career.
• Learning & Development Allowance We provide an allowance to support your ongoing professional growth and skill enhancement.

This is more than a job—its a chance to grow, thrive, and make a real difference. At Reliance Health, your journey matters.