Job Purpose
The Pre-Approval Officer - Medical Benefits will work within the Medical Benefits team and will be responsible for issuance of pre-approvals to medical providers for specific services mentioned in the contractual SOP. The role holder will manage telephone and system approvals and be responsible for confirming cover based on member's eligibility, scheme terms and utilisation history.
Minimum Requirements
- Applicants must be willing to work and relocate to Clark, Pampanga.
- Applicants must be a Filipino citizen or have a relevant residence status
- Medical Degree from a recognized university
- Current License to practice in the Philippines
- Experience working in a medical insurance field is preferred
- 2 years post qualification experience, preferably in Emergency Room, General Practice or Family Medicine
- Computer literate, Proficiency in the MS Office Suite of Software. (Excel/Word/Power Point)
- Proficiency in written and spoken English.
Key Responsibilities And Accountabilities
- Action pre-approval transactions from contracted medical providers in line with agreed operating procedures and service level agreements
- Use medical training, knowledge and departmental guidelines to ensure accurate assessment of pre-approvals
- Ensure consistent application and review of treatment plans to ensure cover in line with contracted pricing
- Complete system and written administration in line with audit requirements and ensure approvals are documented in correct detail to support smooth claims administration.
- Complete activities in line with service agreements while demonstrating ability to prioritise according to medical urgency
- Ensure correct reference to policy of all communication whether verbal or in writing
- Respond to call centre phone queries/ online chat function related to coverage queries and claims in line with published protocols.
- Other tasks may be assigned
