Health Care Member Relations Specialist

iCare HMO; Lugait; Presencial; PHP 300.000 - 420.000; Jornada completa

Descripción de la vacante

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide admin support to Hospital Liaison Officers and the Medical Services Division. The role focuses on assisting members during availments, ensuring proper customer service, and enforcing plan policies for utilization management.

The position involves handling member inquiries, coordinating with hospitals and providers, and maintaining updated knowledge of benefits and LOA issuance.

Formación

• Graduate of any 4-year college course, medical allied (preferred).
• Experience in insurance / HMO and value-adding services preferred.
• Good communication, coordination, and negotiation skills.
• With BPO experience handling healthcare account is an advantage but not required.
• Okay for project-based employment.
• Can start ASAP

Responsabilidades

• Provide admin support to Hospital Liaison Officers and Medical Services Division.
• Assist members during availments and ensure customer service delivery.
• Respond to member queries and complaints promptly and guide accordingly.
• Educate members on coverage, LOA issuance, and benefits.
• Review utilization management cases and gatekeeping of LOAs.
• Coordinate with hospitals and providers to maintain accredited facilities.
• Monitor claims and inform members of acceptance/denial.

Conocimientos

Communication skills

Coordination skills

Negotiation skills

BPO experience (healthcare)

Educación

4-year college degree (medical allied)

Descripción del empleo

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide admin support to Hospital Liaison Officers and the Medical Services Division. The role focuses on assisting members during availments, ensuring proper customer service, and enforcing plan policies for utilization management.

The position involves handling member inquiries, coordinating with hospitals and providers, and maintaining updated knowledge of benefits and LOA issuance.