Medical & Provider Service Representative - Pampanga

1 day ago

Angeles City, Central Luzon, Philippines InLife Health Care Full time $30,000 - $50,000 per year

2.JOB ACCOUNTABILITY

JOB PURPOSE
Preferably an experienced employee specializing in Healthcare and Insurance/HMO - Nurse/Medical Support & Assistant or equivalent. The Medical and Provider Services Representative (MPSR) is responsible for providing effective and efficient administrative support to the Medical and Provider Services Division along with the rest of iCare. They assist iCare members during their availment, mainly on LOA issuance, concerns resolution, and to ensure the proper implementation of good customer service. The incumbent shall also ensure the proper and appropriate implementation of plan policies related to utilization management.

DUTIES AND RESPONSIBILITIES
This role will ensure that iCare members are assisted during their availment to contribute to employee engagement, and retention in proportion but not limited to the medical needs of the company and covered companies and individuals.

Customer Service
a) Acts as reliever for Member Relations Representatives (MRR) deployed in identified clients.

Utilization Management
a)
Ensures proper gatekeeping and utilization management through:
1. Determination of validity of the member status, benefit coverage and maximum available limit prior issuance of LOAs through information garnered from the Medical Account System (MAS).
2. Review of cases and checking necessity of availment and need for medical procedure.
3. Coordination of catastrophic cases to superior for case management.

Relationship Management
a) Builds and maintains good rapport with iCare's designated Hospital Care Director (HCD) in the hospital, iCare's roster of accredited physicians and provider personnel.
b) Assists the Provider Management Division by:
1. Increasing the roster of accredited medical facilities especially physicians.
2. Do on the spot or provisional accreditation of member accessed/requested physicians and/or medical facilities.
3. Updating the records of physicians as the need arises.
4. Conducting orientation/ re-orientation of Accredited Providers.

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