HMO Coordinator & Member Experience Specialist

iCare HMO; Philippines; Vor Ort; PHP 240.000 - 400.000; Teilzeit

Zusammenfassung

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide administrative support to the Hospital Liaison Officers and Medical Services Division, helping insured members during availments and ensuring proper customer service and plan policy implementation.

The role covers utilization management, provider relationship management, and claims-related activities, with focus on maintaining member benefits and smooth service delivery during hospital interactions.

Qualifikationen

• Graduate of a 4-year college course, medical allied preferred.
• Experience in insurance / HMO preferred.
• BPO experience handling healthcare accounts is an advantage.
• Willing to work on a project-based arrangement.
• Can start ASAP.

Aufgaben

• Assist members during availment at accredited facilities and ensure proper policy implementation.
• Address member queries/concerns/complaints promptly and guide on regulations affecting medical services.
• Support utilization management through gatekeeping of status, coverage, and limits.
• Coordinate with Hospital Care Director and provider roster; assist provider management and accreditation.
• Distribute service surveys and collate feedback; monitor claims and reimbursements to members.

Kenntnisse

Communication skills

Coordination

Negotiation skills

BPO experience

Availability

Ausbildung

Bachelor's degree

Jobbeschreibung

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide administrative support to the Hospital Liaison Officers and Medical Services Division, helping insured members during availments and ensuring proper customer service and plan policy implementation.

The role covers utilization management, provider relationship management, and claims-related activities, with focus on maintaining member benefits and smooth service delivery during hospital interactions.