Original listing text, shown exactly as published by the company.
Responsibilities
- Accurate and Efficient Adjudication of Member Availments and Issuance of LOA’s
- Review and process member availments and claims in accordance with company policies, HMO guidelines, medical indication, and PhilHealth regulations.
- Ensure Letters of Authorization (LOAs) are accurately prepared, approved, and issued in a timely manner or within ideal standards.
- Identify and resolve problems concerning availments and LOA issuances to members.
- Maintain complete and accurate data recording for auditing and utilization capture.
- Discharge members efficiently ensuring all documentations and computations are complete and accurate.
- Maintain Effective Call Handling and Timely Log-in
- Respond promptly and professionally to inbound calls from providers.
- Provide accurate information regarding availments, benefits, and LOA’s.
- Maintain daily log-in and call handling metrics in line with departmental standards.
- Follow up on inquiries or escalated cases to ensure timely resolution.
3. Efficient Handling and Coordination of Inquiries and Cases
- Serve as the main point of contact for providers regarding availments, LOAs, and member concerns.
- Coordinate with healthcare providers and internal departments to resolve members’ inquiries and concerns
- efficiently.
- Track the progress of cases and ensure timely resolution.
- Document interactions, updates, and outcomes in the concerned channels.
Qualifications
- Must be willing to work hybrid in Ortigas
- Must be willing to do occasional night shifts
- Familiarity with medical indications for adjudication
- Prior experience in roles such as medical liaison, provider relations, hospital HMO section staff, company nurse, teleconsult nurse, etc., is advantageous
- Willingness to conduct hospital visits
- Proficient problem-solving abilities
- Curious, results-driven, ownership mentality with growth mindset
- Excellent verbal and written communications
- Collaborative team player with the ability to adapt quickly in a fast-paced environment
- Passion for innovation in healthcare
