Member Benefits Officer

MEDICARE PLUS, INC.; Pasig; On-site; PHP 240,000 - 400,000; Full time

Job summary

Medicare Plus, Inc. is seeking a healthcare customer service professional to assist providers with inquiries and verify member coverage.

You will analyze requests to determine if procedures are covered under the member’s health plan and advise providers on approval statuses. The role involves coordinating between patients and providers to administer benefits, handling inquiries, and resolving complaints while ensuring accurate explanations of benefits and eligibility.

Qualifications

• 2+ years of work experience in customer service.
• Above-average communication and interpersonal skills.
• Must be customer-service oriented.
• Must have a keen eye for details.
• Good negotiating skills.
• Proficient in Microsoft Office Applications.
• Graduate of any business-related course.

Responsibilities

• Attend inquiries and questions from providers.
• Verify and check the member’s coverage plan.
• Analyze provider requests for consultation and laboratory procedures within the member’s plan.
• Advise providers on approval status of requests.
• Facilitate administration of health benefits to HMO members through coordination with patients and providers.
• Handle inquiries, concerns, and requests related to health benefits.
• Handle complaints and explain when requests are disapproved and address concerns.
• Conduct orientations for corporate accounts on benefits, inclusion, limitation, eligibility status, and processing procedures for the HMO card.
• Review member plans and utilization.
• Update members’ approved utilization.
• Discuss and explain the healthcare benefits of the member.
• Process and issue letters of authorization to members.

Skills

Communication skills

Interpersonal skills

Customer service oriented

Attention to detail

Negotiation skills

MS Office proficiency

Education

Business-related degree

Tools

Microsoft Office

Job description

Responsibilities:

• Attend inquiries and questions from providers
• Verify and checks the member’s coverage plan
• Analyze the request of the provider for consultation and laboratory procedures if these are covered or within the parameter of the member’s healthcare plan
• Advise the provider regarding the status of approval of the request
• Facilitate the administration of health benefits to all HMO members or cardholders through proper coordination between the patient and the provider
• Handle all inquiries, concerns, and requests of the members relative to their health benefits
• Handle complaints and explains when the request is disapproved and assures that all concerns are answered
• Conduct orientation for corporate accounts on the benefits, inclusion, limitation, eligibility status, and processing procedures in using the HMO card
• Review the member’s plan and utilization
• Updates members’ approved utilization
• Discuss and explain the healthcare benefit of the member
• Processes and issues the letter of authorization to the member

Qualifications:

• Preferably with at least 2 years of work experience in customer service
• Above-average communication and interpersonal skills
• Must be customer-service oriented
• Must have a keen eye for details
• Good negotiating skills
• Proficient in Microsoft Office Applications
• Must be a graduate of any business-related course