HMO Coordinator & Member Relations Specialist

iCare HMO; Meycauayan; On-site; PHP 201,000 - 290,000; Full time

Job summary

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide efficient admin support to the Hospital Liaison Officers and the Medical Services Division. The role involves assisting insured members during availments and ensuring proper implementation of customer service and plan policies.

You will handle utilization management processes, liaise with hospitals and providers, and contribute to the accreditation and claims screening activities.

Qualifications

• Bachelor’s degree or equivalent in any 4-year course, medical allied preferred.
• Experience in insurance/HMO and value-added services preferred.
• Strong communication, coordination, and negotiation skills.
• BPO experience in healthcare accounts is an advantage but not required.

Responsibilities

• Assist members during availments and ensure proper customer service implementation.
• Support Hospital Liaison Officers and Medical Services Division with administrative tasks.
• Ensure proper gatekeeping and utilization management of member status and benefit coverage.
• Build rapport with hospital directors and providers, assist in accreditation and claims screening.

Skills

Communication

Coordination

Negotiation

Education

4-year college degree

Medical allied preferred

Job description

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide efficient admin support to the Hospital Liaison Officers and the Medical Services Division. The role involves assisting insured members during availments and ensuring proper implementation of customer service and plan policies.

You will handle utilization management processes, liaise with hospitals and providers, and contribute to the accreditation and claims screening activities.