HMO Officer

1 week ago

San Juan, National Capital Region, Philippines Public Safety Mutual Benefit Fund, Inc. (PSMBFI) Full time ₱1,200,000 - ₱2,400,000 per year

Duties and Responsibilities

  • Generates utilization metrics based on current company's underwriting or evaluation guidelines
  • Reports to the Supervisor, Claims Section and PCMD Manager regarding member experience, issues in processing and other matters pertaining to the performance of the HMO contract group
  • Essentially responsible for carrying out set strategies of Health Claims team relevant to efficient end-to-end claims processing and provide a delightful customer service
  • Supervises and leads the HMO Contract Team in the end-to-end claims processing
  • Executes strategies and action plans of the department according to goals (KPI) for the year
  • Monitors and ensures prompt resolution on escalated cases including complaints
  • Approves escalated cases within the assigned authority limit
  • Monitors the day-to-day performance of the team, including the daily productivity of the processors through the WIP
  • Conducts spot audit on claims processed by the team
  • Provides coaching and mentoring to the team to ensure compliance on the claims processes and policies
  • Submission of required report that may be required from the head
  • Performs other tasks as may be assigned from time to time related to the assigned tasks

Qualifications

  • Candidate must be a graduate of BS Statistics, BS Applied Mathematics, BS Mathematics, BS Industrial Engineering or any STEM-related undergraduate course with several calculus-based statistics courses (at least 9 units)
  • High proficiency in the use of MS Office (Word, Excel, PowerPoint) applications and Excel VBA
  • With keen attention to details
  • Strong job motivation and initiative
  • Works with minimum supervision
  • Good communication and interpersonal skills
  • Result-oriented, organizational savvy, and has excellent decision-making capacity
  • Leadership skills, Customer-centric, Product Knowledge, Claims processing, Critical thinking
  • Medical knowledge in healthcare operations
  • Knowledge of MS Office applications
  • Good analytical and interpersonal skills

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