Key Responsibilities
- Administer end-to-end HMO enrollment, including new hires, dependents, status updates, terminations, and annual renewals.
- Verify employee and dependent eligibility based on company policies and HMO provider requirements.
- Coordinate with HMO providers to process enrollments, amendments, cancellations, and issuance of HMO membership cards.
- Process and monitor Letters of Authorization (LOAs), guarantee letters, reimbursements, and other HMO-related requests.
- Liaise with HMO account managers, hospitals, clinics, and accredited healthcare providers to facilitate healthcare services and resolve benefit concerns.
- Assist employees with inquiries regarding HMO coverage, benefits, accreditation, claims, reimbursements, and healthcare procedures.
- Investigate and resolve HMO enrollment discrepancies, denied claims, billing issues, and other healthcare benefit concerns.
- Prepare, validate, and reconcile monthly HMO billing statements, enrollment reports, and utilization reports to ensure billing accuracy.
- Maintain accurate and confidential HMO records while ensuring compliance with company policies and the Data Privacy Act.
- Recommend and implement process improvements to enhance HMO administration and employee healthcare support.
Qualifications
- Bachelor's degree in Human Resources, Business Administration, Healthcare Administration, Nursing, Psychology, or a related field.
- At least 1–2 years of experience in handling HMO administration or employee healthcare benefits.
- Strong knowledge of HMO enrollment, dependent management, benefit coverage, healthcare plans, and eligibility requirements.
- Experience coordinating directly with HMO providers, hospitals, clinics, and healthcare account managers.
- Hands-on experience processing HMO enrollments, LOAs, reimbursements, claims coordination, and membership updates.
- Experience reconciling HMO billing statements, enrollment records, and monthly healthcare utilization reports.
- Strong understanding of HMO policies, accreditation networks, healthcare procedures, and claims processes.
- Excellent customer service skills with the ability to explain HMO coverage, benefits, and procedures clearly and professionally.
- Proficient in Microsoft Office, particularly Microsoft Excel (VLOOKUP, Pivot Tables, and data reconciliation).
- Excellent attention to detail and accuracy in managing employee healthcare records and HMO documentation.
- Ability to handle confidential employee and medical-related information with integrity and discretion.
- Strong organizational, communication, coordination, and problem-solving skills.
- Able to manage multiple HMO requests and consistently meet processing deadlines in a fast-paced environment.
Applicants lacking experience in managing Health Maintenance Organization (HMO) benefits will not be considered for the position.
