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Hive Health · 3 months ago

HMO Benefits Liaison

Full-time

Onsite

New Grad, Entry Level

Hive Health is on a mission to make healthcare radically more accessible for all. The HMO Benefits Liaison serves as the key interface between members, healthcare providers, and the HMO teams, responsible for accurate processing of member availments, issuance of Letters of Authorization (LOAs), and ensuring high-quality service delivery.

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Responsibilities

Accurate and Efficient Adjudication of Member Availments and Issuance of LOA’s

Review and process member availments and claims in accordance with company policies, HMO guidelines, medical indication, and PhilHealth regulations

Ensure Letters of Authorization (LOAs) are accurately prepared, approved, and issued in a timely manner or

Within ideal standards

Identify and resolve problems concerning availments and LOA issuances to members

Maintain complete and accurate data recording for auditing and utilization capture

Discharge members efficiently ensuring all documentations and computations are complete and accurate

Maintain Effective Call Handling and Timely Log-in

Respond promptly and professionally to inbound calls from providers

Provide accurate information regarding availments, benefits, and LOA’s

Maintain daily log-in and call handling metrics in line with departmental standards

Follow up on inquiries or escalated cases to ensure timely resolution

Efficient Handling and Coordination of Inquiries and Cases

Serve as the main point of contact for providers regarding availments, LOAs, and member concerns

Coordinate with healthcare providers and internal departments to resolve members’ inquiries and concerns

Efficiently

Track the progress of cases and ensure timely resolution

Document interactions, updates, and outcomes in the concerned channels

Qualification

Medical adjudicationProvider relationsProblem-solvingCommunication skillsTeam collaboration

Required

Must be willing to work hybrid in Ortigas

Must be willing to do occasional night shifts

Familiarity with medical indications for adjudication

Willingness to conduct hospital visits

Proficient problem-solving abilities

Curious, results-driven, ownership mentality with growth mindset

Excellent verbal and written communications

Collaborative team player with the ability to adapt quickly in a fast-paced environment

Passion for innovation in healthcare

Preferred

Prior experience in roles such as medical liaison, provider relations, hospital HMO section staff, company nurse, teleconsult nurse, etc. is advantageous