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Hello! We are caritas Health Shield, Inc. from Quezon City and we are looking for a Member Relations Assistant with 1 year of experience.
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Job Description

MEMBER RELATIONS ASSISTANT:Receives request for assistance from members and non members.Makes standard status verification.Determines the nature of request (e.g. consultation, dental, APE, emergency care and emergency admission).Gathers pertinent medical and other information needed for accurate analysis of the medical case at hand and makes an ADWAP as deemed necessary.Evaluates member’s utilization and if with previous unposted utilization,coordinates with the MCA for proper computation of MBL.Evaluates and recommends approval/disapproval of member’s medical availment based on all information satisfy the RANC guidelines, contract provision, CHAMPFIT and ADWAP.Prepares and issues LOA for approved availment. Explains to the members the reasons for disapproval, makes the necessary notes and endorsement in the RFA for reference. Ensures that a copy of Senior Citizen ID is attached to the LOA.Endorses emergency admission to MCA for continuation of care, monitoring ofMBL and collection of non covered charges if any.Refers to BAR all disapproved cases which needs re-evaluation. (e.g. concealment case, appeal for another MBL).Provides assistance to all branches before and after office hours,during weekends and holidays.Assist branches in analyzing cases and providing medical opinion on the coverability of the cases.Refers all unresolved issues and other concerns immediately to MedicalManager and Medical Head.Refers all queries and concerns that are non-medical to the proper unit or concerned department as soon as possible.

Job Qualification

  • Candidate must possess at least Bachelor's/College Degree in Nursing or equivalent.
  • Preferably a Registered Nurse
  • Working experience is not required. Fresh graduates are welcome to apply.
  • Background in Healthcare as a Nurse/Medical Support & Assistant or equivalent is an advantage.
  • Must be amenable to shifting schedules including grayeyard shift.

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caritas Health Shield, Inc.

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