Registered Nurse · HMO Specialist

Abigail
Samuel

Healthcare Professional & Patient Advocate

Resourceful and detail-oriented healthcare professional with extensive experience in healthcare operations, claims adjudication, call-centre supervision, provider relations, case management, and quality assurance. Skilled in pre-authorization review, claims vetting, fraud detection, provider compliance, and patient-centered care.

AS
5+
Years of
Experience
"Caring is the
essence of nursing."
0
Years Experience
0
Patients Served
0
Certifications
Scroll
5+
Years in
Healthcare
"Caring is the essence of nursing." — Jean Watson

Compassionate Care, Elevated Practice

I am Abigail Ometere Samuel, a dedicated and compassionate Registered Nurse currently working within a Health Maintenance Organization (HMO). My role focuses on bridging the gap between patients and quality healthcare, coordinating care, reviewing authorizations, and supporting clinical case management.

I hold a deep belief that every patient deserves not just treatment, but understanding, dignity, and respect. Whether at the bedside or in a managed care setting, I bring the same commitment to excellence and patient advocacy to everything I do.

I have a Proven ability to streamline processes, improve operational efficiency, ensure compliance with NHIA and organizational standards, and foster strong relationships with patients, providers, and internal teams.

Outside of clinical work, I am continuously seeking professional development opportunities, staying current with evidence-based practices and healthcare policy changes that impact the communities I serve.

Patient-Centred Care
Evidence-Based Practice
Interdisciplinary Collaboration
Continuous Learning

Clinical & Professional Skills

A broad foundation spanning direct patient care, managed care operations, and health systems — built through hands-on experience across hospital and HMO environments.

01

Clinical Nursing

Proficient in patient assessment, medication administration, wound care, IV therapy, and vital signs monitoring with precision and care.

Patient Assessment IV Therapy Wound Care
02

Managed Care

Experienced in utilization review, pre authorizations, discharge planning, and case coordination within HMO frameworks.

Utilization Review Pre Authorizations Case Management Quality Assurance Provider Network and Management
03

Pharmacology

Sound knowledge of drug interactions, dosage calculations, and safe medication practices across multiple therapeutic categories.

Drug Administration Dosage Calc Patient Education
04

Critical Thinking

Skilled at rapidly assessing complex clinical situations, prioritising care needs, and making sound, informed decisions under pressure.

Clinical Reasoning Triage Decision Making
05

Health Informatics

Proficient with Electronic Health Records (EHR), clinical documentation, data entry accuracy, and healthcare management software.

EHR Systems Documentation HMIS
06

Communication

Excellent interpersonal and communication skills — clearly conveying complex medical information to patients, families, and interdisciplinary teams.

Patient Education Team Liaison Counselling

Professional Experience

Timeline
Jun,2025 — Present · Call Center/Provider Operations Supervisor
Nov,2024 — May,2025 · Claims Adjudication/Quality Assurance Specialist
Apr,2024 — Oct,2024 · Healthcare Operations/Provider Compliance Officer(case auditor)
Sep,2021 — Mar,2024 · Quality Assurance Manager
Jan,2021 — Aug,2022 · Registered Nurse
2018 — 2020 · Intern Nurse
Jun,2025 — Present
Current Role
Call Centre & Provider Operations Supervisor
Songhai Health Trust Limited

  • Review and validate provider pre-authorization requests for accuracy, clinical alignment, and adherence to approved tariffs and benefit packages.
  • Escalate and monitor software-related issues to ensure smooth authorization workflows.
  • Manage member and provider inquiries, providing guidance on eligibility, benefits, and service processes.
  • Handle escalated complaints and service recovery to maintain high satisfaction levels.
  • Monitor call-centre performance metrics and mentor junior staff to enhance team productivity.
  • Prepare operational reports highlighting trends, issues, and recommendations for process improvement.
  • Collaborate with Claims, Provider Management, and Quality Assurance teams to resolve crossfunctional challenges.
Nov,2024 — May,2025
Claims Adjudication & Quality Assurance Specialist
Venus Medicare Limited

  • Vetted, captured, and processed medical claims in compliance with organizational policies and approved tariffs
  • Conducted quality assurance audits to confirm accuracy, legitimacy, and completeness of claims.
  • Identified and mitigated potential fraud, overbilling, and coding errors.
  • Reviewed clinical documentation to confirm medical necessity and billing compliance.
  • Coordinated with providers to resolve discrepancies and ensure claims met standards.
  • Maintained accurate records to support financial reconciliation and timely provider reimbursement.
Apr,2024 — Oct,2024
Healthcare Operations & Provider Compliance Officer (Case Auditor)
Metro Health HMO

  • Supervised a multidisciplinary team tasked with ensuring compliance in patient care, billing accuracy, and provider performance in alignment with organizational and healthcare standards.
  • Spearheaded the onboarding and network management of healthcare providers, ensuring they adhered to service-level agreements (SLAs) and met regulatory requirements.
  • Conducted in-depth audits on claims, provider services, and patient records to ensure accuracy and eliminate discrepancies, leading to a 20% reduction in claim rejections.
  • Managed the reconciliation of claims, ensuring that all charges for medical services aligned with agreed tariffs and that the billing process was transparent and compliant with policies.
  • Coordinated the resolution of escalated client-provider disputes, analyzing the root causes of issues and implementing solutions to enhance patient satisfaction and provider relations.
  • Developed and implemented audit frameworks that improved provider compliance rates and increased operational efficiency, driving improvements in the overall quality of care delivery
  • Provided continuous feedback and performance assessments to staff, ensuring adherence to best practices in healthcare management and claims processing.
Sep,2021 — Mar,2024
Branch Operations & Quality Assurance Manager
Ultimate Health Management Services

  • Coordinated claims submissions, audits, verification, and reconciliation across provider networks.
  • Played a pivotal role in quality assurance efforts, ensuring healthcare service delivery met organizational standards, and performed case audits to verify the quality of patient care.
  • Led FMC Keffi branch operations, including claims processing, call-centre supervision, and quality assurance.
  • Implemented workflow improvements that reduced claim turnaround times and improved provider satisfaction.
  • Supervised branch staff and mentored teams in claims processing, quality assurance, and customer service.
  • Ensured compliance with organizational policies, NHIA standards, and documentation protocols
Jan,2021 — Aug,2021
Registered Nurse
Holley Memorial Hospital

  • Delivered nursing care in labor wards, surgical theatres, and recovery units.
  • Monitored patients’ vital signs, administered medications, and prepared patients for procedures.
  • Provided emotional support and patient education to enhance recovery outcomes.
Jan,2018 — Nov,2020
Intern Nurse
Zonal Hospital Okene

  • Assisted with antenatal, prenatal, inpatient, and post-operative care.
  • Administered immunizations and monitored patients with acute and chronic conditions.
  • Supported clinical staff in recovery, wound care, and minor procedures.
  • Mensured adherence to hospital protocols and maintained accurate patient documentation.

Education & Training

🎓
Bachelor of Nursing Science (B.NSc)
Ahmadu Bello University, Zaria.
2024 - Date
📜
Registered Nurse Licence
Kogi State College of Nursing
November 2020 · Active
📚
Senior Secondary School Certificate (SSCE)
Government Science Secondary School, Adogo
June 2017

Licences & Certifications

Committed to maintaining the highest standard of clinical practice through recognised certifications and continuous professional development.

❤️
Advanced Cardiovascular Life Support (ACLS)
Koinonia, 2024
💓
Basic Life Support (BLS)
Koinonia, 2024
🩺
Integrated Management of Childhood Illnesses
November 2020
📋
Health Insurance Basics
November 2022
🔐
Business Acumen
July 2023
🌿
Customer Service and Experience
July 2023

Get In Touch

Whether you're a healthcare employer, a collaborating professional, or someone looking for guidance — I'd love to hear from you. Let's build something meaningful together.

📧
abigailometere36@gmail.com
📍
Abuja, Nigeria
🏥
Open to Healthcare Opportunities
Message sent — I'll be in touch soon.