HMO Coordinator & Member Relations Specialist

iCare HMO; Cebu City; On-site; PHP 335,000 - 502,000; Full time

Job summary

iCare HMO seeks an HMO Coordinator / Member Relations Representative to provide admin support across Medical Services and Sales/Marketing, guiding members through availment and benefits.

Responsibilities include utilization management, provider relations, and claims screening, ensuring proper LOA issuance and timely customer service. Immediate start and project-based options may apply.

Qualifications

• 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.
• BPO experience handling healthcare accounts is an advantage but not required.
• Okay for project-based employment.
• Can start ASAP.

Responsibilities

• Provide admin support to Hospital Liaison Officers and the Medical Services Division and Sales/Marketing to insured members.
• Assist members during availment and ensure proper customer service and plan policy implementation.
• Perform utilization management and gatekeeping tasks to assess validity of status and coverage.
• Build and maintain rapport with Hospital Care Directors and accredited providers.
• Assist provider management with accreditation, records updates, and claims screening.
• Monitor claims, inform members of acceptance/denial, and assist with check releases.

Skills

Communication skills

Coordination

Negotiation

BPO healthcare experience

Education

Bachelor's degree in a 4-year course (medical allied preferred)

Job description

iCare HMO seeks an HMO Coordinator / Member Relations Representative to provide admin support across Medical Services and Sales/Marketing, guiding members through availment and benefits.

Responsibilities include utilization management, provider relations, and claims screening, ensuring proper LOA issuance and timely customer service. Immediate start and project-based options may apply.