Operations Manager

About the Role

• The Operations Manager will be responsible for coordinating the operational engine of LifeCome HMO, including provider relations, member services, enrolment workflows, claims administration, referral processes, authorisation rules, customer support, reporting, compliance coordination and service-quality monitoring.
• The successful candidate must be able to translate LifeCome HMO’s approved product architecture into real operational processes that hospitals, clinics, pharmacies, diagnostic centres, members, employers, diaspora sponsors, cooperatives and institutional clients can understand and use.

Key Responsibilities

1. HMO Operations Management

• Lead the daily operations of LifeCome HMO, ensuring that enrolment, member verification, provider access, authorisation, claims processing, customer support and reporting are properly coordinated.

Provider Network Coordination

• Support the onboarding, credentialing and management of hospitals, clinics, pharmacies, laboratories, diagnostic centres and specialist providers. Ensure that provider agreements, tariffs, referral rules, service limits and claims protocols are clearly implemented.

Claims and Authorisation Oversight

• Coordinate claims workflows, pre-authorisation requests, emergency approvals, referral documentation, provider billing review and service validation. Work with medical, finance and compliance teams to minimise leakage, fraud, overbilling and unnecessary utilisation.

Member and Client Services

• Ensure members, families, employers, cooperatives, diaspora sponsors and institutional clients receive clear guidance, timely support and professional service. Build a culture of responsiveness, accuracy and accountability.

Product Implementation

• Support the operational launch of LifeCome HMO’s product categories, including Individual Care, Family Care, Diaspora Family Care, SME Care, Corporate Care, Cooperative & Community Care, Public Sector & PPP Care, Institutional & Association Care and approved care-pathway add-ons.

Regulatory and Compliance Coordination

• Work with management and compliance advisers to ensure LifeCome HMO’s operations align with NHIA requirements, approved benefit structures, provider-network obligations, data protection requirements and internal governance standards.

Reporting and Performance Monitoring

• Prepare operational reports covering enrolment, claims activity, provider utilisation, complaints, authorisations, service turnaround time, member support issues, provider performance and operational risks.

Process and Systems Development

• Develop SOPs, workflow templates, provider-service protocols, claims checklists, escalation pathways, call-centre scripts, member-service procedures and internal operating manuals.

Digital Operations Support

• Work with technology teams to support member portal, provider portal, employer portal, digital ID, claims tracking, care navigation, telehealth and customer-support tools.

Team Leadership

• Supervise operations officers, provider relations officers, claims support staff, customer service officers and field coordinators. Build a disciplined, service-oriented and performance-driven operations team.

Required Experience

The ideal candidate should have:

• Minimum of 5–8 years’ relevant experience in HMO operations, healthcare administration, managed care, hospital administration, health insurance, claims management or provider-network management.
• Strong understanding of the Nigerian HMO/health insurance market.
• Experience working with hospitals, clinics, pharmacies, laboratories or diagnostic centres.
• Practical knowledge of claims processing, provider billing, pre-authorisation, referrals and service limits.
• Strong understanding of member enrolment, customer service and complaint resolution.
• Ability to develop operational systems, SOPs, workflows and reporting templates.
• Strong leadership, communication, negotiation and problem-solving skills.
• Good working knowledge of Microsoft Office, CRM tools, reporting systems and digital workflow platforms.
• An understanding of NHIA-regulated health insurance operations will be a strong advantage.

Preferred Background

Candidates from any of the following backgrounds are strongly encouraged to apply:

• HMO operations management
• Healthcare provider relations
• Claims administration
• Hospital operations
• Health insurance administration
• Managed-care coordination
• Medical network management
• Healthcare customer-service leadership
• Public health programme operations

Key Skills Required

• Operational discipline
• Provider negotiation and relationship management
• Claims review and cost-control awareness
• Member-service excellence
• Regulatory and compliance awareness
• Strong documentation and reporting skills
• Team coordination
• Problem-solving under pressure
• Data-driven decision-making
• Ability to build systems from early-stage launch to scale

Performance Expectations

The Operations Manager will be expected to help LifeCome HMO achieve:

• Smooth operational launch of approved HMO products
• Effective onboarding of providers
• Timely member enrolment and activation
• Clear claims and authorisation workflows
• Strong member and client satisfaction
• Reduced operational leakage and billing disputes
• Practical provider tariff and service-limit implementation
• Accurate operational reporting
• Compliance-ready documentation
• Scalable systems for growth across individuals, families, employers, cooperatives, diaspora sponsors and institutional clients