Terms and Conditions

25.1 OFFICE OF THE MANAGING DIRECTOR (MD)
    a. The Managing Director shall be the highest Executive Authority within FRSC Health Maintenance Limited (FHML) and shall be responsible for the overall
leadership, direction, and strategic growth of the organization. The MD shall be the primary custodian of FHML’s mission, vision, and values, and ensures that the organization’s activities align with its corporate objectives and statutory
obligations. Key responsibilities include:
        i. Leadership and Strategic Planning

        ii. Policy Oversight and Governance

        iii. Financial and Contractual Authority
        iv. Stakeholder Engagement and Representation
v. Performance Oversight and Review
b. The Managing Director ensures that FHML remains a compliant, efficient, and Innovative leader in Nigeria’s health maintenance industry

25.2 FINANCE AND ACCOUNTS

The Finance and Accounts Department is responsible for the prudent management of FHML’s financial resources, ensures transparency, accountability, and alignment with corporate objectives. It oversees all budgeting, payment, revenue collection, and financial reporting activities, ensuring compliance with statutory requirements and international accounting standards. a. Monitor day-to-day financial operations within the company, such as payroll, invoicing, and other transactions. b. Oversee finance and Accounts department employees, including financial
assistants and accountants. c. Contract outside services for tax preparation, auditing, banking, investments, and other financial needs as necessary. d. Track the company’s financial status and performance to identify areas for potential improvement. e. Seek out methods for minimizing financial risk to the company. f. Research and analyze financial reports and market trends. g. Provide insightful information and expectations to Executive Management to aid in long-term and short-term decision-making. h. Review financial data and prepare monthly and annual reports. i. Present financial reports to board members, stakeholders, executives, and clients in formal meetings. j. Stay up to date with technological advances and accounting software used for financial purposes. k. Establish and maintain financial policies and procedures for the company. l. Understand and adhere to financial regulations and legislation.

25.3 ADMINISTRATION AND HUMAN RESOURCE

The Administration & Human Resources (AHR) Department shall be responsible for managing FHML’s human capital and ensuring the smooth administrative operations of the organization. It plays a central role in workforce planning, employee relations, and the provision of support services to all departments. The department ensures that FHML attracts, develops, and retains a skilled, motivated, and compliant workforce while maintaining a conducive and productive work environment. It shall also perform the following:
a. Facilitate AHR departmental processes. b. Prepare AHR documents. c. Help employees with their questions and issues. d. Assist with employee hiring, onboarding, and training. e. Help with employee health plans, payroll, and benefits. f. Organize and maintain personnel records. g. Update internal databases (e.g., record sick or maternity leave). h. Prepare AHR documents such as employment contracts and new hire guides, and revise company policies. i. Liaise with external partners, such as insurance vendors, and ensure legal
compliance. j. Create regular reports and presentations on AHR metrics (e.g., turnover rates). k. Resolve employee queries about AHR-related issues. l. Provide relevant employee information (e.g., leave of absence, sick days, and work schedules) to the Finance and Accounts department
m. Arrange travel accommodations and process expense forms. n. Participate in AHR projects (e.g., help organize a job fair event).

25.4 LEGAL ADVISER /COMPANY SECRETARY

a. The Legal Adviser shall be the principal legal authority for FRSC Health Maintenance Limited (FHML), responsible for managing legal risks, ensures
regulatory compliance and that all organizational activities comply with applicable laws, regulations, and contractual obligations. Provides legal guidance, mitigates risks, and safeguards FHML’s interests in all engagements with stakeholders, including healthcare providers, enrollees, vendors, and regulatory bodies. b. Key Responsibilities:
i. Legal Advisory & Compliance
ii. Contract Management iii. Risk Management & Litigation
iv. Corporate Governance support
v. Claims & Dispute Resolution
vi. Regulatory & Compliance Oversight
vii. Documentation & Legal Records
viii. Legal Training & Awareness
25.5 HEAD MEDICAL SERVICES (HMS)
a. The Medical Services Department is the clinical and quality assurance arm of FHML, responsible for overseeing all medical aspects of service delivery to enrollees. It ensures that treatments, referrals, and medical interventions are medically appropriate, cost-effective, and compliant with National
Health Insurance Authority (NHIA) regulations, FRSC guidelines, and FHML’s internal standards. This department serves as the link between enrollees, healthcare providers, and other FHML units to guarantee timely, ethical, and high-quality medical care. b. Key Responsibilities: 

i. Accredit healthcare providers and conduct facility assessments
ii. Define and review clinical coverage, limits, and exclusions
iii. Review claims for accuracy and detect fraud or abuse patterns
iv. Develop clinical protocols and monitor quality of care
v. Control healthcare costs and reduce unnecessary services
vi. Resolve medical complaints and support patient care decisions
vii. Analyze clinical trends and support organizational decision making
viii. Support clinical systems and digital health solutions
ix. Handle urgent cases and provide clinical decision support

x. Collaborate with claims, finance, underwriting, and customer service units

xi. Approve admissions, procedures, and specialized care.
xii. Ensure adherence to healthcare regulations and standards
xiii. Train staff and support continuous professional development
xiv. Monitor provider performance and manage relationships
xv. Ensure fairness, clinical appropriateness, and patient safety

25.6 CLAMINS (QUALITY CONTROL/ASSURANCE)

a. The Head of Claims is responsible for the end to end claims management
function, ensuring timely processing, accuracy, fraud control, and cost efficiency while maintaining provider and enrollee satisfaction. The role balances clinical
judgment, financial stewardship, and operational efficiency. b. Key Responsibilities:
i. Ensure claims vetting and smooth management processes. ii. Manage claims payment and resolve medical cases requiring special attention. iii. Examine healthcare providers’ claims using the tariff agreement to
determine authenticity and payment. iv. Decline fraudulent claims and state causative reasons. v. Forward approved claims to the team lead for review and final approval. vi. Investigate complicated claims and escalate to the team lead, if necessary. Carry out physical inspections at assigned providers’ offices using the checklist. vii. Investigate complicated claims by checking case folders and speaking to enrollees and doctors. viii. Update providers’ dashboards and implement resolutions.

25.7 OPERATIONS

a. The Operations Department is the backbone of FHML’s service delivery, responsible for coordinating, monitoring, and optimizing all activities that directly impact enrollee satisfaction and healthcare provider performance. The Department plays a critical role in ensuring that FHML delivers healthcare services that are timely, reliable, and compliant with both regulatory and contractual obligations. Itis the link between strategy and execution, ensuring that every department’s work contributes to excellent enrollee experiences. Operations department ensures that the company’s day-to-day operations align with FHML’s strategic objectives, service-level agreements, and regulatory requirements
b. Key responsibilities include:
i. Carry out routine inspections of healthcare providers’ facilities. ii. Carry out registration of healthcare providers. iii. Provide expert advice on health promotion and disease prevention.

iv. Cooperate with the management team to initiate procedures, regulations, and programs to benefit patients and support healthcare providers in line with best practices. v. Oversee healthcare provider network development and management. vi. Oversee care coordination, provider relations, claims administration, and wellness programs. vii. Oversee member services activities and client relationship management. viii. Assist in marketing health plans to private and public organizations. ix. Possess full knowledge of NHIA quality assurance processes and procedures.

25.8 HEALTH INSURANCE UNDERWRITING

a. Health insurance underwriters review and analyze applications for insurance coverage. Assisted by underwriting software and related programs, they assess the risk involved in insuring an individual or company and determine the premiums for the requested coverage. b. Key Responsibilities
i. Review all new applications and insert specific information (e.g., income, expenses, and health details) into underwriting software. ii. Assess each applicant’s medical history and determine whether they have any pre-existing conditions. iii. Analyze the recommendations provided by the software for each application. iv. Decide whether to approve applications or decline approval. v. If approved, determine the extent of coverage and calculate the premium based on the applicant’s risk assessment. vi. Consult with agents or insurance processors about the final decision.

25.9 AUDIT

b. The Audit Department shall be FHML’s independent oversight mechanism that ensures compliance, transparency, and accountability in all operational
and financial activities. It systematically reviews processes and records, to safe guards organizational integrity and promote best practices across all
units. The Department detects weaknesses and supports management in strengthening systems that protect FHML’s reputation, resources, and stakeholders.

Key Responsibilities include:
i. Compliance Verification
ii. Operational Audits
iii. Financial Audits
iv. Risk Assessment and Mitigation
v. Special Investigations
vi. Reporting and Follow-Up
vii. Capacity Building

25.10 INFORMATION AND COMMUNICATION TECHNOLOGY (ICT)

a. The Information Technology (IT) Department shall be responsible for thedesign, implementation, maintenance, and security of FHML’s digital infrastructure. It ensures that all operational processes are supported by reliable, secure, andefficient technological systems, enabling smooth communication, data management, and service delivery. The department also plays a critical role in protectingtheintegrity of enrollee, providers, and corporate data in compliance with NigeriaDataProtection Regulation (NDPR) and other applicable laws. b.Key Responsibilities include:
i. Configure, deploy and maintain ICT systems and databases, includingnetworks, servers, and telecommunications; troubleshoot and addressissuesto ensure optimal performance. ii. Configure and maintain applications and user devices; provide timely andquality service delivery, technical support, and advice to user requests;
ensure proper user access to agency business data and information. iii. Maintain inventory of ICT equipment, hardware, and software; ensureadequate supply and functionality; collaborate with relevant staff toprovideinput to budgets for ICT-related expenses. iv. Coordinate relationships with suppliers to facilitate delivery of ICT-relatedservices that meet CRS business requirements and needs. v. Support capacity-building initiatives, remotely or on-site, for staff and partners to ensure consistent adoption and use of ICT applications. vi. Partner with program staff to integrate ICT4D solutions in program implementation. vii. Deploy technical support for ICT4D solutions integrated within programming interventions. viii. Prepare statistical reports on ICT-related data and metrics. Implementmeasures as needed to ensure required standards are met.

25.11 CALL CENTRE
a. The Call Centre which is FHML’s primary communication hub, serves as thefirstpoint of contact for enrollees, healthcare providers, and the public. It managesinquiries, complaints, claims follow-ups, and emergency notifications in a
professional, timely, and customer-focused manner. b.Key Responsibilities include:
i. Inbound/outbound Call Management
ii. Complaint Handling and Resolution
iii. Emergency Call Handling
iv. Call Documentation and Reporting by logging all calls in the FHML Call
Management System (CMS) with complete details, including date, time, caller, issue, resolution, and escalation path and generation of daily, weekly, andmonthly call reports for analysis of trends, service gaps, and commonissues. v. Maintain records for compliance audits and performance tracking. vi. Service Quality and Performance Monitoring
vii. Confidentiality and Data Protection. viii. Ensure, all information shared over the phone are handled in line withFHML’s Data Privacy Policy and applicable regulations.

25.12 HEAD SECRETARIAT
a. The Head of Secretariat shall be responsible for providing administrative, documentation, and coordination support to the Managing Director, Director -AHR, and all strategic committees within FHML. This office ensures that all governanceprocesses run efficiently, records are well maintained, and communication betweendepartments and leadership is seamless. b. Key responsibilities include:
i. Policy & Document Management
ii. Communication & Liaison Functions
iii. Event & Protocol Management iv. Compliance Support
v. Confidentiality & Ethical Conduct

25.12 MARKETING / CUSTOMER RELATIONSHIP MANAGEMENT

a. Organize and maintain up-to-date health information in both paper files andelectronic systems. b. Check data for accuracy and ensure proper billing for insurance reimbursement. c. Manage patient information, medical histories, physician exams, test results, treatments, and services provided. d. Ensure patient care conforms to individual HMO/NHIA requirements andpolicies. e. Obtain all necessary HMO codes as and when due. f. Act as a relationship officer with HMOs/NHIA. g. Source new clients while maintaining relationships with existing clients. h. Arrange meetings and presentations.

i. Coordinate or participate in promotional activities or trade shows, working with developers, advertisers, or market plans or services.

j. Negotiate contracts with potential clients to secure their business.