Member Relations & Health Utilization Specialist

iCare HMO; Metro Manila; On-site; PHP 312,000 - 580,000; Full time

Job summary

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide administrative support to the Hospital Liaison Officers and Medical Services Division. You will assist insured members during availments, ensuring proper customer service and adherence to plan policies.

The role focuses on utilization management, member communication, and coordination with accredited facilities, physicians, and provider management for efficient service delivery.

Qualifications

• Graduate of any 4-year college course (preferred).
• Experience in insurance / HMO and value-adding services preferred.
• BPO experience handling healthcare accounts is an advantage but not required.
• Okay for project-based employment.
• Can start ASAP.

Responsibilities

• Provide effective administrative support to Hospital Liaison Officers and Medical Services/ Sales and Marketing Divisions.
• Assist members during availments and ensure proper customer service implementation.
• Ensure member queries and complaints are attended to promptly and guided appropriately.
• Maintain up-to-date knowledge on medical updates, utilization management, and plan benefits.
• Issue LOAs and assist MD scheduling of appointments and other services.
• Support utilization management through gatekeeping and review of cases for necessity and coverage.
• Build rapport with hospital directors, providers, and rostered physicians; assist provider management with accreditation and records updates.
• Monitor claims status and inform members of acceptances/denials and disbursements.

Skills

Communication

Coordination

Negotiation

Education

4-year college degree

Job description

iCare HMO is seeking an HMO Coordinator / Member Relations Representative to provide administrative support to the Hospital Liaison Officers and Medical Services Division. You will assist insured members during availments, ensuring proper customer service and adherence to plan policies.

The role focuses on utilization management, member communication, and coordination with accredited facilities, physicians, and provider management for efficient service delivery.