Qualifications:

• Bachelor’s Degree in any field
• Atleast 1-2 years experience health maintenance organization (HMO), healthcare, or insurance industry, specifically in customer service, claims processing, or provider coordination
• Proficient in Microsoft Office applications (Word, Excel, Outlook, and PowerPoint).
• Knowledgeable in HMO processes, including Letter of Authorization (LOA) issuance, claims review and reimbursement, and provider accreditation.
• Familiarity with medical terminology and in-patient/out-patient procedures.

Responsibilities

1. Submission of bimonthly clinic report on actual number of LOA issued.

2. Review claims document from <account name> employee for its completeness and update status of approval/denial.

3. Issue LOA and coordinate with Generali Alarm Center for LOA concerns.

4. Assist employees in case there are problems on availment whether in-D.patient or out-patient.

5. Facilitates/Assist requests for orientation, annual physical examination, executive check-up and wellness activities.

6. May assist in the following items as needed:

• Process additional enrollment for newly born child, married, regularized, and promoted individuals.
• Screen membership based on hierarchy and check necessary requirements.
• Process cancellation of dependents for members and deceased members.
• In charge of initial checking of GLAPI’s billing for membership, billback, dental and other billing
• Tracks releasing of GLAPI health cards.

7. Undertakes all other tasks that may be assigned from time to time.