In-house patient care officer

MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.

MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.

MediCard is currently looking for assertive, dynamic and energetic individuals to fill up the following vacancy:

The ILO acts as the face of MediCard within healthcare facilities, guiding members throughout their healthcare journey, facilitating benefit utilization, coordinating with healthcare providers and hospital stakeholders, and promoting quality healthcare outcomes while ensuring compliance with MediCard policies, medical necessity standards, and utilization management principles.

The role extends beyond traditional customer service by delivering an exceptional member experience that aligns with MediCard's mission of making healthcare accessible, affordable, predictable, and easy to navigate for Filipinos.

Primary Purpose of the Role

To help members access:

• The right care
• At the right time
• In the right care setting
• At the right cost through virtual channels while ensuring a positive healthcare experience that strengthens confidence in MediCard's services.

Key Role Dimensions

• Member Advocate - Supports members in understanding healthcare benefits, services, and treatment options through virtual interactions.
• Healthcare Navigator - Guides members through healthcare pathways, network providers, and healthcare processes remotely.
• Care Coordinator - Facilitates efficient communication among members, healthcare providers, hospital-based Liaison Officers, and MediCard departments.
• Utilization Steward - Promotes appropriate and medically necessary utilization of healthcare services.
• Digital Experience Ambassador - Represents MediCard's commitment to service excellence through phone, email, chat, video consultation, and digital platforms.

Key Responsibilities

1. In house Healthcare Navigation Responsibilities
   • Verify member eligibility and benefit coverage.
   • Facilitate timely processing of approvals and authorizations.
   • Explain coverage, benefit limitations, exclusions, and requirements clearly and accurately.
   • Guide members through authorization and healthcare access processes.
   • Support efficient documentation and case management.
   • Assist members with benefit-related concerns and inquiries.
   Success Indicators
   • High member satisfaction ratings
   • Improved healthcare navigation experience
   • Increased first-contact resolution
   • Reduced member confusion and escalations
2. Benefit Implementation and Management Responsibilities
   • Verify member eligibility and benefit coverage.
   • Facilitate timely processing of approvals and authorizations.
   • Explain coverage, benefit limitations, exclusions, and requirements clearly and accurately.
   • Guide members through authorization and healthcare access processes.
   • Support efficient documentation and case management.
   • Assist members with benefit-related concerns and inquiries.
   Success Indicators
   • Compliance with authorization turnaround times
   • Reduced benefit-related complaints
   • Accurate benefit interpretation and application
   • Improved member understanding of benefits
3. Care Coordination and Utilization Management Responsibilities
   • Facilitate implementation of MediCard utilization management policies.
   • Coordinate with providers, hospitals, hospital-based LOs, and internal clinical teams.
   • Promote evidence-based and medically necessary healthcare utilization.
   • Guide members toward the most appropriate level of care.
   • Escalate complex medical necessity concerns to designated healthcare professionals.
   • Assist in discharge planning, continuity of care, and follow-up coordination when applicable.
   Success Indicators
   • Appropriate utilization of healthcare resources
   • Reduced unnecessary admissions and procedures
   • Effective coordination among stakeholders
   • Positive provider collaboration
4. Member Experience Excellence Responsibilities
   • Deliver compassionate and professional service through virtual channels.
   • Practice active listening and empathy during member interactions.
   • Manage customer concerns, complaints, and escalations promptly.
   • Conduct service recovery activities when necessary.
   • Maintain proactive communication throughout the member journey.
   • Ensure every member interaction reflects MediCard's brand promise.
   Success Indicators
   • Member Satisfaction Score targets achieved
   • Increased Net Promoter Score (NPS)
   • Timely complaint resolution
   • High quality monitoring scores
5. Virtual Provider and Stakeholder Coordination Responsibilities
   • Maintain positive working relationships with network providers and healthcare facilities.
   • Coordinate with hospital-based Liaison Officers for admitted members.
   • Promote collaborative problem-solving among stakeholders.
   • Support provider awareness of MediCard processes.
   • Gather provider and member feedback for continuous improvement.
   Success Indicators
   • Positive provider satisfaction ratings
   • Reduced operational disputes
   • Improved stakeholder collaboration

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.