Primary Care HMO Officer

We are expanding our Healthcare Team and are looking for dedicated professionals to support our Local HMO Account. This role offers a stable career, growth opportunities, and the chance to make a meaningful impact by supporting patient access to quality healthcare.

If you are service-oriented, detail-focused, and passionate about healthcare, this role is for you. Be a PRIMARY CARE HMO OFFICER (CSR)

Job Qualifications

• Graduate of any four-year medical-related course (non-negotiable)
• Open to fresh graduates with hospital internship experience
• Knowledge of medical terminology, diseases, diagnostics, and procedures
• Experience in BPO healthcare or HMO accounts is an advantage
• Experience handling HMO approvals is a plus
• Background in hospital admissions is an advantage
• Proficient in English and Filipino, both written and verbal
• Willing to work onsite in Ortigas Center, Pasig
  
  

• Handle inbound calls and emails related to benefits, coverage, MBL, provider access, and policy inquiries
• Update and maintain accurate member records and case documentation
• Validate HMO requests, approvals, and benefit eligibility
• Assist in verifying medical cases, diagnostics, procedures, and claim admissibility
• Utilize quality monitoring tools and systems to ensure compliance
• Prepare internal quality and performance reports
• Recommend process improvements to enhance efficiency and member satisfaction
• Support general customer service initiatives
• Perform other related tasks as assigned by management
• Conduct outbound calls to follow up on pending cases and coordinate with healthcare providers
• Process and issue Inpatient and Outpatient approvals within required turnaround times
• Act as a frontline HMO representative, providing professional