HMO Member Relations & Utilization Specialist

iCare HMO; Eastern Manila District; On-site; PHP 279,000 - 469,000; Full time

Job summary

iCare HMO is seeking a capable HMO Coordinator / Member Relations Representative (MRR) to support the Hospital Liaison Officers and Medical Services Division. You will assist insured members during availments, help implement plan policies, and contribute to utilization management and customer service excellence.

The role involves coordinating with hospital care directors and provider networks, handling LOAs and referrals, and ensuring smooth member experience across departments.

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.
• Open to project-based employment and can start ASAP.

Responsibilities

• Customer Service: assist members during availment and respond to queries in a timely manner.
• Utilization Management: gatekeeping and review of need for medical procedures.
• Relationship Management: build rapport with hospitals and providers, manage accreditation and claims.

Skills

Communication skills

Coordination

Negotiation

Education

Bachelor's degree

Job description

iCare HMO is seeking a capable HMO Coordinator / Member Relations Representative (MRR) to support the Hospital Liaison Officers and Medical Services Division. You will assist insured members during availments, help implement plan policies, and contribute to utilization management and customer service excellence.

The role involves coordinating with hospital care directors and provider networks, handling LOAs and referrals, and ensuring smooth member experience across departments.