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