HMO Healthcare Representative

13 hours ago

Cebu City P, Philippines iCARE - Insular Health Care, Inc. Full time ₱240,000 - ₱480,000 per year

JOB REQUIREMENTS:

  • Experience in insurance / HMO and value-adding services preferred.
  • Okay for project-based employment.
  • Can start ASAP

A. JOB PURPOSE

The HMO Coordinator or Member Relations Representative (MRR)/HMO Officer is responsible for providing effective and efficient administrative support to the Hospital Liaison Officers Department together with the rest of the departments of the Medical Services Division and the Sales and Marketing Division to insured members. They assist iCare members during their availments mainly and ensure the proper implementation of Customer Service. Experience and ensure the proper and appropriate implementation of plan policies resulting in utilization management.

B. 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.

1. Customer Service

1.1. Ensure that iCare members availing of medical services in accredited medical facilities are assisted accordingly.

1.2. Ensure that members' queries, concerns and/or complaints are attended to in a timely and appropriate manner prior to elevating this to the Medical Director.

1.3. Keep abreast with current regulations and policies affecting medical services and implementation and provide proper guidance to all concerned.

1.4. Be up to date on medical updates, utilization management, newly onboarded and renewed account benefits.

1.5. Maintain company spiels and lines that will entice members to call them regarding their benefit including medical network inquiries, concerns and LOA issuances.

1.6. Ensure that the member's coverage and benefits is discussed appropriately and issue the letter of authorization (LOA).

2. Utilization Management

2.1. Ensure proper gatekeeping and utilization management through:

2.1.1. 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).

3. Relationship Management

3.1. Build and maintain good rapport with iCare's designated Hospital Care Director (HCD) in the hospital, iCare's roster of accredited physicians and provider personnel.

3.2. Assist the Provider Management Division by:

3.2.1. Increasing the roster of accredited medical facilities especially physicians.

Job Type: Full-time

Pay: From Php20,000.00 per month

Application Question(s):

  • What is your expected salary?

Experience:

  • Customer service: 1 year (Preferred)

Work Location: In person

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