Medical Benefits Specialist in Clark Pampanga
- 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
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
-Ensure consistent application and review of treatment plans to ensure cover in line with
-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.
Please send your resume to firstname.lastname@example.org
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