HMO Coordinator & Member Relations Specialist

iCare HMO; Makati; On-site; PHP 223,000 - 391,000; Part time

Job summary

iCare HMO is seeking an HMO Coordinator / Member Relations Representative (MRR) to provide administrative support to the Hospital Liaison Officers and Medical Services Division. You will assist insured members during availments and ensure proper customer service implementation.

You will handle utilization management gatekeeping, coordinate with hospitals and providers, process LOAs, and help maintain a positive member experience through timely communication and accurate documentation.

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

Responsibilities

• Assist iCare members during availments at accredited facilities.
• Respond to members' queries, concerns and/or complaints promptly.
• Stay updated on regulations and policies affecting medical services and implementation.
• Explain benefits and LOA issuance to members.
• Assist MD scheduling and LOA processing.
• Distribute service evaluation surveys and ensure target confidence level and margin of error are met.
• Maintain provider networks and on-spot or provisional accreditation of physicians/facilities.
• Monitor claims and inform members of acceptance/denial and release of checks.

Skills

Good communication

Coordination

Negotiation

Education

Graduate of a 4-year college course, medical allied (preferred)

Job description

iCare HMO is seeking an HMO Coordinator / Member Relations Representative (MRR) to provide administrative support to the Hospital Liaison Officers and Medical Services Division. You will assist insured members during availments and ensure proper customer service implementation.

You will handle utilization management gatekeeping, coordinate with hospitals and providers, process LOAs, and help maintain a positive member experience through timely communication and accurate documentation.