Assistant Manager, Hospital Liaison & Member Benefits

iCare HMO; Makati; On-site; PHP 360,000 - 600,000; Full time

Job summary

iCare HMO in Metro Manila seeks a dedicated Health Liaison Officer to monitor confinements of members in accredited facilities, answer queries, and ensure compliance with evolving policies.

You will collaborate with hospital staff, review charges and LOAs, support discharge planning, and help optimize member benefits while upholding company standards in Health & Safety and Quality Assurance.

Responsibilities

• Ensure proper monitoring of confinements of iCare members in accredited medical facilities.
• Address members’ queries, concerns and complaints promptly before elevating to the HLO Head.
• Keep abreast with regulations affecting medical services and provide proper guidance.
• Be up to date on medical updates, utilization management, newly onboarded and renewed account benefits.
• Maintain company spiels and lines to entice members to discuss benefits including LOA issuances.
• Visit admitted members to discuss coverage and benefits and issue LOA.
• Monitor daily the member’s progress chart to assess needs and current medical condition.
• Assist the member during discharge by checking hospital charges and professional fees to maximize benefits.
• Build rapport with iCare’s Hospital Care Director and accredited doctors and provider staff.
• Visit hospital administrators and doctors to address concerns (unpaid claims, payments, and policies).
• Assist in creating processes to ensure alignment with Health & Safety, QA, Marketing & Brand, and Risk management policies.
• Ensure gatekeeping and utilization management through: validity of member status, benefit coverage and LOA issuance from MAS; case review; coordination of catastrophic cases for case management.
• Distribute service evaluation surveys and ensure targeted confidence level and margin of error monthly.
• Receive comments, suggestions and feedback and collate survey results.
• Assist Provider Management by increasing the roster of accredited facilities and physicians; accreditation of providers as needed; updating physician records; releasing documents as required.
• Coordinate with accredited facilities for payment, follow-ups, or lifting suspensions.
• Work with internal and external leaders affecting department operations.
• Contribute to create processes for Medical Audit and ensure proper application.
• Participate in process reviews and development of new work processes and policies relating to Utilization Management.

Job description

iCare HMO in Metro Manila seeks a dedicated Health Liaison Officer to monitor confinements of members in accredited facilities, answer queries, and ensure compliance with evolving policies.

You will collaborate with hospital staff, review charges and LOAs, support discharge planning, and help optimize member benefits while upholding company standards in Health & Safety and Quality Assurance.