HMO Officer

5 days ago

Pasig, National Capital Region, Philippines Hive Health Full time

Ready to make an impact? At Hive Health and HPPI, a subsidiary of Hive Health, we're on a mission to make healthcare radically more accessible for all—and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we'd love to meet you

Job Summary

The HMO Officer serves as the key interface between members, healthcare providers, and the HMO teams.

The role is responsible for accurate processing of member availments, issuance of Letters of Authorization (LOAs), timely call handling, and efficient coordination of inquiries and cases to ensure high-quality service delivery.

Responsibilities

  1. Accurate and Efficient Adjudication of Member Availments and Issuance of LOA's

  • Review and process member availments and claims in accordance with company policies, HMO guidelines,

  • medical indication, and PhilHealth regulations.

  • Ensure Letters of Authorization (LOAs) are accurately prepared, approved, and issued in a timely manner or

  • within ideal standards.

  • Identify and resolve problems concerning availments and LOA issuances to members.

  • Maintain complete and accurate data recording for auditing and utilization capture.

  • Discharge members efficiently ensuring all documentations and computations are complete and accurate.

  1. Maintain Effective Call Handling and Timely Log-in

  • Respond promptly and professionally to inbound calls from providers.

  • Provide accurate information regarding availments, benefits, and LOA's.

  • Maintain daily log-in and call handling metrics in line with departmental standards.

  • Follow up on inquiries or escalated cases to ensure timely resolution.

3. Efficient Handling and Coordination of Inquiries and Cases

  • Serve as the main point of contact for providers regarding availments, LOAs, and member concerns.

  • Coordinate with healthcare providers and internal departments to resolve members' inquiries and concerns

  • efficiently.

  • Track the progress of cases and ensure timely resolution.

  • Document interactions, updates, and outcomes in the concerned channels.

Qualifications

  • Must be willing to work hybrid in Ortigas

  • Must be willing to do occasional night shifts

  • Familiarity with medical indications for adjudication

  • Prior experience in roles such as medical liaison, provider relations, hospital HMO section staff, company nurse, teleconsult nurse, etc., is advantageous

  • Willingness to conduct hospital visits

  • Proficient problem-solving abilities

  • Curious, results-driven, ownership mentality with growth mindset

  • Excellent verbal and written communications

  • Collaborative team player with the ability to adapt quickly in a fast-paced environment

  • Passion for innovation in healthcare

Join our team as we revolutionalize healthcare in the Philippines—and beyond

Day 1 benefits for full-time employees – because we practice what we preach Enjoy comprehensive healthcare coverage for you and your dependent, and paid time off from the start.
Grow with us – mentorship, career development, and learning opportunities to help you thrive.
Global connections – gain insights and support from top minds at Harvard, Stanford, and beyond.

  • HMO Officer

    5 days ago

    Pasig, National Capital Region, Philippines Hive Health Full time

    Ready to make an impact? At Hive Health and HPPI, a subsidiary of Hive Health, we're on a mission to make healthcare radically more accessible for all—and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we'd love to meet youJob...

  • HMO Officer

    5 days ago

    Pasig, National Capital Region, Philippines Hive Health Full time

    Ready to make an impact? At Hive Health and HPPI, a subsidiary of Hive Health, we're on a mission to make healthcare radically more accessible for all—and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we'd love to meet you Job Summary...

  • Administrative Officer

    5 days ago

    Pasig, National Capital Region, Philippines TOPLC Biomedical, Inc. Full time ₱800,000 - ₱1,200,000 per year

    Key Responsibilities:General Office Management:Handle day-to-day administrative tasks, including answering phone calls, managing emails, and responding to internal and external inquiries promptly.Scheduling and Coordination: Organize schedules, meetings, and appointments for staff and management, ensuring efficient time management.Inventory and Equipment...

  • Availment Officer

    5 days ago

    Pasig, National Capital Region, Philippines Hive Health Full time

    Ready to make an impact? At Hive Health and HPPI, a subsidiary of Hive Health, we're on a mission to make healthcare radically more accessible for all—and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we'd love to meet youJob...

  • Sales Officer

    3 days ago

    Pasig, National Capital Region, Philippines MEDICARE PLUS, INC. Full time ₱300,000 - ₱600,000 per year

    Would you like to join a company that truly values its employees? How would it feel to work in a space free from gender bias? Imagine the satisfaction of going home every day feeling happy and fulfilled. If this sounds like your ideal environment, submit your resume now at Medicare Plus Inc., where happiness at work is part of our cultureCompany...

  • Availment Officer

    5 days ago

    Pasig, National Capital Region, Philippines Hive Health Full time

    Ready to make an impact? At Hive Health and HPPI, a subsidiary of Hive Health, we're on a mission to make healthcare radically more accessible for all—and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we'd love to meet youJob...

  • Availment Officer

    5 days ago

    Pasig, National Capital Region, Philippines Hive Health Full time

    Ready to make an impact? At Hive Health and HPPI, a subsidiary of Hive Health, we're on a mission to make healthcare radically more accessible for all—and we need passionate, driven individuals to help us make it happen. If you thrive in a fast-paced, innovative environment and want to work on solutions that truly matter, we'd love to meet you Job Summary...

  • Credit Officer

    5 days ago

    Pasig, National Capital Region, Philippines Boutique Outsource Solutions Pty Ltd Full time ₱1,200,000 - ₱2,400,000 per year

    Are you detail-oriented and passionate about delivering accurate credit assessments? Do you have experience in Australian residential mortgage loan processing and enjoy working in a fast-paced, collaborative environment? Join us as a Credit Officer and play a key role in ensuring the quality of our loan book while delivering exceptional service to our...

  • Compliance Officer

    5 days ago

    Pasig, National Capital Region, Philippines Connext Global Solutions Inc Full time $40,000 - $80,000 per year

    Connext is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.We are currently looking for a Compliance Officer who will be working with Connext's Client in the United States of...

  • Credit and Collection Officer

    7 days ago

    Pasig, National Capital Region, Philippines J-K International Language Center Full time ₱300,000 - ₱420,000 per year

    Client Profile: One of the largest and most competitive finance company offers loans services for over 9 years in the Philippine Industry.Position: Credit and Collection OfficerIndustry: Financial CompanySalary: Php25,000 – Php35,000Location: Ortigas, Pasig CitySchedule: Monday – Friday (Dayshift)Work Set up: Work on siteBenefits: Government mandated...