Healthcare Navigator & Member Advocate

AIA; Cebu City; On-site; PHP 240,000 - 420,000; Full time

Job summary

MediCard Phils., Inc. is seeking assertive, dynamic and energetic individuals to join our team as Member Advocates, Healthcare Navigators, Care Coordinators, Utilization Stewards, and Brand Ambassadors.

This role focuses on helping members access the right care at the right time and cost, while delivering a positive healthcare experience. You'll guide members through benefits, coordinate with providers, and ensure services are medically appropriate and compliant with policies.

Responsibilities

• Serve as the primary point of contact for members within assigned healthcare facilities.
• Guide members in accessing appropriate healthcare services and providers.
• Assist members in understanding healthcare benefits, limitations and options.
• Provide support throughout admission, confinement, treatment, and discharge processes.
• Facilitate referrals and coordination of care as needed.
• Assist members in navigating complex healthcare situations.
• Verify member eligibility and benefit coverage.
• Facilitate timely processing of approvals and authorizations.
• Explain the coverage, limitations and exclusions, as well as requirements.
• Ensure services rendered are within approved benefits and coverage guidelines.
• Support efficient claims and documentation processes.
• Facilitate implementation of MediCard utilization management policies.
• Coordinate with healthcare providers regarding covered healthcare services.
• Support medically necessary and evidence-based healthcare practices.
• Promote treatment in the most appropriate level of care.
• Escalate complex medical necessity concerns to designated clinical teams.
• Deliver compassionate and professional member support.
• Practice active listening and empathy during member interactions.
• Manage concerns and complaints promptly.
• Conduct service recovery activities when necessary.
• Ensure every member interaction reflects MediCard's brand promise.
• Develop positive working relationships with hospital personnel and physicians.
• Promote collaborative problem-solving.
• Support provider awareness of MediCard processes.
• Participate in provider engagement activities.
• Gather provider feedback for service improvement.
• Maintain accurate documentation and records.
• Comply with Data Privacy Act requirements and company policies.
• Adhere to established service level agreements (SLAs).
• Ensure timely reporting and escalation of critical issues.
• Participate in quality improvement initiatives.
• Promote MediCard’s brand promise.
• Educate members regarding Medicard’s services.
• Participate in member education campaigns.
• Support brand awareness initiatives within healthcare facilities.
• Demonstrate professionalism and service excellence consistently.

Job description

MediCard Phils., Inc. is seeking assertive, dynamic and energetic individuals to join our team as Member Advocates, Healthcare Navigators, Care Coordinators, Utilization Stewards, and Brand Ambassadors.

This role focuses on helping members access the right care at the right time and cost, while delivering a positive healthcare experience. You'll guide members through benefits, coordinate with providers, and ensure services are medically appropriate and compliant with policies.