Responsibilities:

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

Qualifications:

• Must be a graduate of any MEDICAL ALLIED course (Nursing, Biology, Physical Therapy, Rad Tech, Pharmacy, etc)
• Preferably with at least 1 year of work experience in customer service or in an HMO company
• 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