Quality Assurance and Benefits Manager 410 views

Directorate: Services 

Location: National Health Insurance Authority Headquarters

Job Purpose

Provide strategic and technical leadership in quality assurance and benefits management, ensuring that contracted healthcare providers deliver safe, appropriate, accessible and quality health services in accordance with NHIA standards, benefit packages, policies and contractual requirements.

KEY RESPONSIBILITIES

1. Develop and implement quality assurance frameworks, standards, indicators and assessment tools.
2. Lead the review and implementation of NHIA benefit packages, tariffs, policies and guidelines.
3. Coordinate provider quality assessments, credentialing and performance monitoring.
4. Identify quality gaps and oversee corrective and continuous quality improvement actions.
5. Monitor benefit utilization, provider performance, inappropriate use and potential abuse.
6. Collaborate with Claims, Actuarial, Membership, Finance, ICT and other functions on quality, utilization and benefits matters.
7. Support analysis of utilization, effectiveness and financial implications of benefit packages.
8. Ensure beneficiary entitlements are appropriately delivered and protected.
9. Maintain quality assurance and benefits monitoring systems, records and reports.
10. Lead and supervise staff and ensure effective use of resources.

QUALIFICATIONS AND PROFESSIONAL REQUIREMENT

A candidate for the position should possess:

• Master’s Degree in Health Services Management, Healthcare Quality Improvement, Quality Management System, Public Health, Health Administration, Medicine, Nursing, Pharmacy, Health Insurance or a related field.
• Professional training in quality assurance, healthcare quality improvement, health insurance or related areas is an advantage.

EXPERIENCE

The candidate should have:

• At least 5–7 years’ relevant experience, including 3 years in a supervisory/managerial role.
• Demonstrated experience in healthcare quality assurance, provider contracting, performance monitoring and quality improvement.
• Experience in health benefits design and management, health insurance, health insurance claims management, utilization review and monitoring, evaluation, accountability and learning is highly desirable.

APPLICATION

Applications, including copies of relevant certificates and CV, should be submitted to hr@nhia.gm

For detailed information on the positions, please contact hr@nhia.gm

Deadline: 31 August 2026.