HMO Assistant

4 days ago

San Juan, National Capital Region, Philippines Public Safety Mutual Benefit Fund, Inc. (PSMBFI) Full time ₱150,000 - ₱250,000 per year

Duties and Responsibilities

  1. Ensure proper gatekeeping and utilization management through:

  2. Determination of validity of the member status, benefit coverage, and maximum available limit prior issuance of approvals from information gathered in existing Member's Medical Information System.

  3. Review of cases and checking necessity of availment and need for medical procedure
  4. Coordination of catastrophic cases to superior for case management
  5. Verification of patient's membership status
  6. Administration of health benefit requests
  7. Assistance in the issuance of approval to all registered members
  8. Maintains an updated file of all related contracts, policies and procedures on availment of medical and diagnostic services, rates of procedures, and list of accredited doctors

Qualifications

  • Relevant Bachelor's Degree (preferably in the Hospitality Management and Marketing)
  • 0-1 year experience; Customer Service Background
  • Experience in insurance/ HMO and value-adding services preferred
  • Customer Service Representative, Clerical, Communications, and Computer Skills (Microsoft and Google Applications)
  • Organizational Skills, Attention to details, Team Player, With High Degree of Integrity
  • Good communication, coordination, and negotiation skills
  • With BPO experience handling healthcare account is an advantage

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