Benefits Associate - HMO

Asticom Technology Inc; Taguig; On-site; PHP 240,000 - 300,000; Full time

Job summary

Asticom Technology Inc. is seeking a focused HMO Administrator to manage end-to-end enrollment, eligibility, and billing processes for employees and dependents. You will coordinate with HMO providers, process LOAs and reimbursements, and maintain confidential health records while ensuring compliance with company policies.

Strong Excel skills and customer service are essential. The role requires meticulous attention to detail, the ability to resolve enrollment discrepancies, and excellent

Qualifications

• Bachelor's degree in Human Resources, Business Administration, Healthcare Administration, Nursing, Psychology, or related field.
• At least 1–2 years of experience in handling HMO administration or employee healthcare benefits.
• Strong knowledge of HMO enrollment, dependent management, benefit coverage, healthcare plans, and eligibility requirements.
• Experience coordinating directly with HMO providers, hospitals, clinics, and healthcare account managers.
• Hands-on experience processing HMO enrollments, LOAs, reimbursements, claims coordination, and membership updates.
• Experience reconciling HMO billing statements, enrollment records, and monthly healthcare utilization reports.
• Excellent customer service skills with the ability to explain HMO coverage, benefits, and procedures clearly.
• Proficient in Microsoft Excel (VLOOKUP, Pivot Tables, and data reconciliation).

Responsibilities

• Administer end-to-end HMO enrollment, including new hires, dependents, status updates, terminations, and annual renewals.
• Verify employee and dependent eligibility based on company policies and HMO provider requirements.
• Coordinate with HMO providers to process enrollments, amendments, cancellations, and issuance of HMO membership cards.
• Process and monitor Letters of Authorization (LOAs), guarantee letters, reimbursements, and other HMO-related requests.
• Liaise with HMO account managers, hospitals, clinics, and accredited healthcare providers to facilitate healthcare services and resolve benefit concerns.
• Assist employees with inquiries regarding HMO coverage, benefits, accreditation, claims, reimbursements, and healthcare procedures.
• Investigate and resolve HMO enrollment discrepancies, denied claims, billing issues, and other healthcare benefit concerns.
• Prepare, validate, and reconcile monthly HMO billing statements, enrollment reports, and utilization reports to ensure billing accuracy.
• Maintain accurate and confidential HMO records while ensuring compliance with company policies and the Data Privacy Act.
• Recommend and implement process improvements to enhance HMO administration and employee healthcare support.

Skills

Attention to detail

Customer service

Communication

Problem solving

Time management

Education

Bachelor's degree in HR, Business Administration, Healthcare Administration, Nursing, Psychology, or related field

Tools

Microsoft Excel

Job description

Key Responsibilities

• Administer end-to-end HMO enrollment, including new hires, dependents, status updates, terminations, and annual renewals.


• Verify employee and dependent eligibility based on company policies and HMO provider requirements.


• Coordinate with HMO providers to process enrollments, amendments, cancellations, and issuance of HMO membership cards.


• Process and monitor Letters of Authorization (LOAs), guarantee letters, reimbursements, and other HMO-related requests.


• Liaise with HMO account managers, hospitals, clinics, and accredited healthcare providers to facilitate healthcare services and resolve benefit concerns.


• Assist employees with inquiries regarding HMO coverage, benefits, accreditation, claims, reimbursements, and healthcare procedures.


• Investigate and resolve HMO enrollment discrepancies, denied claims, billing issues, and other healthcare benefit concerns.


• Prepare, validate, and reconcile monthly HMO billing statements, enrollment reports, and utilization reports to ensure billing accuracy.


• Maintain accurate and confidential HMO records while ensuring compliance with company policies and the Data Privacy Act.


• Recommend and implement process improvements to enhance HMO administration and employee healthcare support.

Qualifications

• Bachelor's degree in Human Resources, Business Administration, Healthcare Administration, Nursing, Psychology, or a related field.


• At least 1–2 years of experience in handling HMO administration or employee healthcare benefits.


• Strong knowledge of HMO enrollment, dependent management, benefit coverage, healthcare plans, and eligibility requirements.


• Experience coordinating directly with HMO providers, hospitals, clinics, and healthcare account managers.


• Hands‑on experience processing HMO enrollments, LOAs, reimbursements, claims coordination, and membership updates.


• Experience reconciling HMO billing statements, enrollment records, and monthly healthcare utilization reports.


• Strong understanding of HMO policies, accreditation networks, healthcare procedures, and claims processes.


• Excellent customer service skills with the ability to explain HMO coverage, benefits, and procedures clearly and professionally.


• Proficient in Microsoft Office, particularly Microsoft Excel (VLOOKUP, Pivot Tables, and data reconciliation).


• Excellent attention to detail and accuracy in managing employee healthcare records and HMO documentation.


• Ability to handle confidential employee and medical‑related information with integrity and discretion.


• Strong organizational, communication, coordination, and problem‑solving skills.


• Able to manage multiple HMO requests and consistently meet processing deadlines in a fast‑paced environment.

Applicants lacking experience in managing Health Maintenance Organization (HMO) benefits will not be considered for the position.