HMO Member Relations Specialist

iCare HMO; Iloilo City; On-site; PHP 240,000 - 360,000; Full time

Job summary

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide administrative support within the Medical Services and Sales divisions, assisting insured members during availments and ensuring customer service.

The role emphasizes utilization management, relationships with hospitals and providers, and processing LOAs, with a focus on policy implementation and member benefits.

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

• The HMO Coordinator or Member Relations Representative (MRR)/HMO Officer provides administrative support to the Hospital Liaison Officers Department and other divisions to insured members.
• Assist members during availments and ensure proper Customer Service.
• Perform utilization management including LOA issuance and gatekeeping.
• Build rapport with hospitals, providers, and accredited physicians.
• Coordinate accreditation activities and monitor provider records and claims status.

Skills

Communication skills

Coordination

Negotiation

Insurance / HMO experience

BPO experience (healthcare)

Education

4-year college degree (medical allied preferred)

Job description

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide administrative support within the Medical Services and Sales divisions, assisting insured members during availments and ensuring customer service.

The role emphasizes utilization management, relationships with hospitals and providers, and processing LOAs, with a focus on policy implementation and member benefits.