HMO Manager

1 week ago

Quezon City, Philippines 1Life Inc. Full time

The HMO Manager oversees and manages the company’s health maintenance organization (HMO) accounts, ensuring efficient processing of employee benefits, claims, and healthcare services. The role ensures compliance with policies, maintains strong provider relations, and provides quality support to employees regarding their healthcare benefits. Key Responsibilities: Develop, implement, and manage HMO policies and procedures for the company. Coordinate with HMO providers regarding enrollments, utilization, claims, renewals, and membership updates. Monitor employee utilization of HMO benefits and address concerns or disputes. Ensure accurate and timely processing of HMO-related transactions (e.g., billings, reimbursements, approvals). Conduct regular evaluation and negotiation with HMO providers to secure competitive healthcare packages. Serve as the point of contact between employees and healthcare providers. Prepare reports on HMO utilization, claims, and cost efficiency. Provide orientations and updates to employees regarding their HMO coverage and benefits. Ensure compliance with government regulations, company policies, and contractual agreements with HMO providers. Lead and supervise the HMO team or staff involved in healthcare benefits administration. Qualifications: Bachelor’s degree in Business Administration, Human Resources, Nursing, or related field. Minimum of 3–5 years experience in HMO or healthcare benefits administration, with at least 2 years in a supervisory/managerial role. Strong knowledge of HMO processes, benefits management, and healthcare regulations. Excellent negotiation, communication, and problem-solving skills. Detail-oriented, organized, and able to manage multiple accounts. Proficiency in MS Office applications (Word, Excel, PowerPoint). Can start asap Location: Banawe, Quezon City Work Schedule: Monday - Saturday #J-18808-Ljbffr

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