medical relations associate i

3 days ago

Manila, National Capital Region, Philippines Forticare Health Systems International, Inc. Full time

Functions

Underwrites and process new business application form, review contracts and accreditation documents. Coordinate with the members for medical history and records and initiate letter of guarantee and/or letter of authorization for members availment process. Process reimbursement and other related medical claims.

Duties and responsibilities :

Issue LOA/GL for members benefit availment requestsProcess Reimbursement and medical claimsCoordinate with Providers Division for hospital, clinic and doctor's accreditationUnderwrite and process MAF, documents and Medical RecordsVerify information and review membership plan applicationsUnderwrites medical questionnaires and medical examination reports.Underwrites/processes application formsAssists clients in complying to medical requirementsPrepares, files, and maintains approval, requirement, and transmittal letters, and attends to client's requests or queriesEncodes medical impairments and update MIB recordRegularly report to the office of Chief Internal Administrator and Medical Director for updatesAssists in the documentation of accreditation of hospital, clinics and/or doctors.Other duties that can be assigned by the department.RequirementsMust be a graduate BS Nursing with Certification and/or Licensed and/or any medical related degreeKnowledge of complex disease conditions, treatments, tests and medicationsPreferably with 1 to 3 years work experience in a health maintenance organization is a plusWith decisive and analytical mindKnowledgeable to MS Office applications and basic editingAbove average communication and interpersonal skillsMust be customer-service orientedMust be willing to work on shifting schedule if neededWilling to work in Malate ManilaMust have the following requirements: SSS, Pag-ibig, Philhealth, TINProficient in Microsoft applications (Word, Excel, Powerpoint)Must be detail-oriented and able to multi-taskCandidate must be able to start ASAP

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