Healthcare Navigator & Member Advocate

AIA Hong Kong and Macau; Philippines; On-site; PHP 391,000 - 580,000; Full time

Job summary

MediCard Phils., Inc. is a leading HMO in the Philippines, focused on service-oriented health care. We seek energetic individuals to assist members in accessing the right care, at the right time, and at the right cost.

The role covers navigation, benefit implementation, care coordination, and creating a superior member experience, with emphasis on compassion, clear communication, and collaboration with providers to ensure quality care.

Qualifications

• Excellent verbal and written communication skills in English.
• Ability to explain complex healthcare benefits clearly.
• Strong interpersonal skills and empathy in member interactions.

Responsibilities

• Serve as primary 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 coverage, limitations, and exclusions, as well as requirements.
• Ensure services rendered are within approved benefits and coverage guidelines.
• Support efficient claims and documentation processes.
• Coordinate with healthcare providers regarding covered services.
• 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.

Skills

Communication skills

Empathy

Customer service mindset

Healthcare navigation knowledge

Job description

MediCard Phils., Inc. is a leading HMO in the Philippines, focused on service-oriented health care. We seek energetic individuals to assist members in accessing the right care, at the right time, and at the right cost.

The role covers navigation, benefit implementation, care coordination, and creating a superior member experience, with emphasis on compassion, clear communication, and collaboration with providers to ensure quality care.