HMO Staff, Paranaque

An HMO Staff works for a Health Maintenance Organization (HMO) and is responsible for assisting members with their healthcare benefits, processing medical claims, coordinating

with hospitals and doctors, and ensuring members receive the services covered by

their health plan in the Philippines.

1. Assist members with inquiries regarding healthcare benefits, coverage, and policies.
2. Verify member eligibility and health plan details before providing services.
3. Process and monitor medical claims, requests, and documentation.
4. Coordinate with hospitals, clinics, and healthcare providers for approvals and services.
5. Issue or facilitate Letters of Authorization (LOA) for medical consultations, procedures, or admissions.
6. Maintain and update member records and healthcare information accurately.
7. Provide customer service support and help resolve member concerns or complaints.
8. Ensure compliance with company policies, healthcare regulations, and confidentiality standards.
9. Prepare and submit reports and documentation related to HMO services and transactions.
10. Assist in promoting efficient healthcare service delivery to members.

JOB REQUIREMENTS:

• Bachelors degree in healthcare administration, Nursing, Business Administration, or a related field
• Excellent customer service and communication skills.
• Strong organizational ability and attention to detail.
• Strong customer service orientation
• Basic knowledge of health insurance policies and procedures
• Ability to handle confidential medical information
• Good organizational and problem-solving skills
• Proficiency in Microsoft Office and computer systems