Inpatient Services Supervisor

Maxicare Healthcare Corporation; Makati; On-site; PHP 279,000 - 446,000; Full time

Job summary

Maxicare Healthcare Corporation in Makati is seeking a dedicated customer service professional to support LOA reviews, explain coverage details, and assist admitted members during MAG discussions. You will handle escalations with internal and external partners, propose practical solutions, and guide members to Maxicare networks and exclusive benefits.

Collaboration with your supervisor will ensure accurate reporting and timely responses.

Qualifications

Responsibilities

• Review, evaluate, and process LOA with minimal supervision, explaining coverage and non-coverage during MAG discussions with members.
• Analyze escalations and address concerns related to eligibility and coverage for internal/external partners within standard turnaround time.
• Offer first-hand solutions for captured complaints and refer to internal departments as needed.
• Guide members to Maxicare Primary Care Networks, Preferred Partners, and Low-Cost Facilities, while highlighting exclusive benefits.
• Collaborate with the supervisor to meet team goals and prepare accurate, comprehensive reports.
• Execute campaigns and tasks during manpower shortages, BCP events, or when service levels are low to keep operations responsive.

Job description

• Minimal to zero supervision to review, evaluate, and process Letters of Authorization (LOA) following established procedures and professionally explain coverage and non-coverage details during Member’s Availment Guide (MAG) discussion with admitted members.
• Analyze escalations and address concerns related to internal and external partners regarding eligibility, coverage (professional fees, miscellaneous &, etc.), and procedures within the standard turn-around time.
• Offer first-hand solutions for captured complaints and endorse them to internal departments (MRG, UEF, Sales) as necessary.
• Offer and steer members to the Maxicare Primary Care Networks, Preferred Partners, and Low-Cost Facilities, while highlighting Maxicare's exclusive benefits including recommended packages, and assisting members in understanding the available services.
• Works directly with the immediate superior in meeting the team and company’s common goal. Prepare and submit reports ensuring that data is accurate and comprehensive.
• Execute various campaigns and tasks as needed during manpower shortages, business continuity planning (BCP) events, or when Service Level (SL) for other teams or sub-units are critically low, ensuring operations remain smooth and responsive to immediate demands.