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Medical Benefits Specialist in Clark Pampanga

Angeles, Pampanga, Philippines
November 09, 2019


Medical Benefits Specialist in Clark Pampanga

MInimum Qualifications:

- Must be willing to work/relocate to Clark, Pampanga

- Must be a Nurse or Pharmacist Graduate

- License is a big Plus but not required

- 2 years recent experience in a Clinical Setting is a must

- Must be willing to work full-time and on shifting schedule

Job Purpose:

The Pre-Approval Coordinator - 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.

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.

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