HMO Staff

5 days ago

Dasmariñas A, Philippines Dasmarinas City Medical Center Full time

Job Title: HMO Staff

Department: Health Maintenance Organization (HMO) Operations

Reports To: HMO Supervisor / Operations Manager

Job Summary

The HMO Staff member provides administrative and operational support to ensure efficient delivery of healthcare services to HMO members. This role involves coordinating member services, processing documentation, assisting healthcare providers, and ensuring compliance with organizational policies and healthcare regulations.

Key Responsibilities

  • Assist HMO members with inquiries regarding benefits, coverage, and healthcare services
  • Process membership enrollment, eligibility verification, and updates
  • Coordinate with hospitals, clinics, and healthcare providers for referrals and authorizations
  • Review and process claims, billing documents, and medical records accurately
  • Maintain and update member information in HMO systems and databases
  • Ensure compliance with HMO policies, healthcare regulations, and confidentiality standards
  • Provide customer service support via phone, email, or in person
  • Prepare reports, correspondence, and documentation as required
  • Support quality assurance and utilization review activities
  • Perform other administrative or operational duties as assigned

Qualifications

  • Bachelor's degree in Healthcare Administration, Business Administration, or a related field (preferred)
  • Relevant experience in healthcare administration, insurance, or HMO operations
  • Knowledge of healthcare insurance processes and medical terminology
  • Strong organizational and multitasking skills
  • Excellent communication and customer service skills
  • Proficiency in basic computer applications and healthcare information systems

Preferred Qualifications

  • Experience working in an HMO, insurance company, or healthcare facility
  • Familiarity with claims processing, utilization review, or provider relations
  • Training in healthcare regulations and compliance

Physical Requirements

  • Ability to sit for extended periods
  • Ability to perform repetitive administrative tasks
  • Occasional lifting of office materials

Work Environment

  • Office-based or healthcare administrative setting
  • Standard business hours; may require overtime during peak periods

Job Type: Full-time

Work Location: In person

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