Provider Services Lead - Member & Provider Experience

Maxicare Healthcare Corporation; Davao de Oro; Hybrid; PHP 420,000 - 540,000; Full time

Job summary

Maxicare Healthcare Corporation in the Philippines seeks a Provider Services Supervisor - E2E (IC) to oversee the inpatient team's operations, improving service delivery and ensuring accurate authorization processing.

You will handle LOA reviews, explain coverage, manage escalations with partners, promote Maxicare networks, and generate reports, while maintaining confidentiality and adapting to staffing needs in a hybrid role.

Qualifications

• Bachelor’s degree preferred; or 2+ years college with 2 years Customer Service experience.
• Excellent verbal and written communication skills.
• Proficient in data entry and transaction processing with attention to detail.
• Proficient in using Google Applications (Gmail, GSheets, GSlides, etc.).

Responsibilities

• Review, evaluate, and process LOA, explaining coverage during MAG discussions with admitted members.
• Analyze escalations with internal/external partners on eligibility and coverage within standard turnaround time.
• Provide first-hand solutions for captured complaints and escalate to MR G, UEF, Sales as needed.
• Guide members to Maxicare Primary Care Networks, Preferred Partners, and Low-Cost Facilities; highlight exclusive benefits.
• Prepare and submit reports with accurate, comprehensive data.
• Support campaigns and tasks during manpower shortages, BCP events, or low Service Level in other teams.

Skills

Communication

Customer Service

Problem Solving

Organizational Skills

Adaptability

Confidentiality

Education

Bachelor’s degree in Healthcare or Medical field

2+ years Customer Service experience

Tools

Salesforce

Genesys

Google Apps

Job description

Maxicare Healthcare Corporation in the Philippines seeks a Provider Services Supervisor - E2E (IC) to oversee the inpatient team's operations, improving service delivery and ensuring accurate authorization processing.

You will handle LOA reviews, explain coverage, manage escalations with partners, promote Maxicare networks, and generate reports, while maintaining confidentiality and adapting to staffing needs in a hybrid role.