Member Benefit Officer

2 weeks ago


Pasig City, Philippines Medicare Plus, Inc. Full time

- Responds to inquiries and questions from providers and subscribers.
- Verifies and checks the member’s coverage plan.
- Analyzes provider requests for consultations and laboratory procedures to determine if they are covered under the member’s healthcare plan.
- Advises providers about the approval status of their requests.
- Facilitates the administration of health benefits for all HMO members or cardholders by ensuring proper coordination between patients and providers.
- Addresses all inquiries, concerns, and requests from members regarding their health benefits.
- Handles complaints and explains the reasons for any disapproved requests, ensuring that all concerns are addressed.
- Conducts orientation sessions for corporate accounts on benefits, inclusions, limitations, eligibility status, and the procedures for using the HMO card.
- Reviews members’ plans and utilization.
- Updates approved utilization records in the HMPlus system.
- Discusses and explains members' healthcare benefits.
- Processes and issues Letters of Authorization (LOA) to members.
- Coordinates and collaborates with key team members for planning and execution.
- Researches and reviews new medical trends and materials that align with our needs.
- Organizes Medical Concierge materials and documents by establishing and maintaining organized files.
- Monitors project timelines and the calendar of activities within the department regarding requirements and other projects.
- Provides support for various tasks and duties as assigned, which may include research, data compilation, customer service, analysis, and program management.
- Upholds the Data Privacy Act and protects the company by keeping all information confidential.
- Performs other assigned tasks as needed.



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