1. 1. Renders basic nursing care such as,
2. first-aid treatment, wound dressing, etc.
3.  
4. 2. Conducts initial medical assessment of
5. members through vital signs-taking prior
6. to actual consultation with the Retainer Physician.
7.  

3. Assists the Corporate Retainer Physician

when performing a physical examination.

1. 4. Monitors and maintains records of
2. daily consultations and work clearances.
3.  
4. 5. Dispenses over-the-counter medicines

1. provided by the account.
2.  

• Must be a registered nurse with an active PRC license

• Preferably with training in Basic Life Support (BLS), First Aid and IVT

• Must have a Basic Occupational Safety and Health (BOSH) Certification

Experience in regulatory compliance is an advantage

• Must be able to work independently, possess a high sense of responsibility, good judgment, and decision-making skills.

Contact Center Specialist  – Medical

1. 1. Facilitates member’s availment

1.  
2. 2. Screens and assess coverage or
3. non-coverage of availment (for
4. readily-coverage or non-coverage cases.)
5.  

3. Grants coverage based on the set

approval limits per member according to

member’s benefits program per Service

agreement (SA) / Consolidated Sales

Documentation (CSD).

• Candidate must be a graduate of Bachelor degree in Nursing

• Preferably a Registered Nurse

• At least with 2 years working experience in

Hospital setting

• Applicants  must be willing to work on a shifting schedule

1. 1. Utilizes staffing models for new or adjusted
2. forecasted assumptions.

1. 2. Perform analysis to validate the process
2. compliance and provide trend and/early
3. warning analysis

3. Prepares presentation materials of

finalized statistical reports to the AVP and

VP for Operation

•  Candidate must be a graduate of Bachelor’s Degree in Information Technology or any related course.

• Preferably with 1 to 2 years experience specializing in Customer Service

• Advance in Microsoft Excel

• Team player and willing to work on a minimum supervision

• Willing to work ASAP

Accounts Officer – Consumer Luzon Renewal Business Intermediary/Direct

1. 1. Generates/expands sales revenues
2. from an existing portfolio of accounts
3. (renewal business) and manages
4. the accounts to ensure customer retention.
5.  

1. 2. Achieves the sales target based on
2. assigned accounts

3. Handles brokers and agents’ performance

and quotas

• Candidate must be a graduate of any four (4) year course

• Must exhibit excellent sales aptitude, negotiation and presentation skills

• Must be self-motivated, independent and competitive

• Should have the ability to deal with different types of people

• Strong written and communication skills

• Highly proficient in Microsoft office

Accounts Officer – Consumer Luzon New Business Direct

1. 1. Generates leads through Cold calls, Referral, and Saturation per Area assigned.

1. 2. Acquire new business corporate accounts with  Maxicare Plus or Corporate Program.

3. Discuss and presents a proposal to prospect clients.

• Candidate must be a graduate of any four (4) year course

• Must exhibit excellent sales aptitude, negotiation and presentation skills

• Must be self-motivated, independent and competitive

• Should have the ability to deal with different types of people

• Strong written and communication skills

• Highly proficient in Microsoft office

Accounts Officer – Consumer Luzon Renewal Business Regional

1. 1. Manages consumer and corporate account
2. to ensure its renewal to achieve set sales target.
3.  

1. 2. Ensures that the terms & conditions
2. of the contract of the client are properly
3. & accurately implemented

3. Conducts timely visits based on account size

to provide utilization and concern handing

reports to the accounts.

• Candidate must be a graduate of any four (4) year course

• Must exhibit excellent sales aptitude, negotiation and presentation skills

• Must be self-motivated, independent and competitive

• Should have the ability to deal with different types of people

• Strong written and communication skills

• Highly proficient in Microsoft office

Accounts Officer – New Business Direct

1. 1. Achieves 100% of assigned business target
2.  

1. 2. Submits and provides baseline
2. information on industries assigned.
3.  

1. 3. Provides client information and updates
2. & customer feedback to the BDM.

4 .   Monitors assigned accounts and leads

on a monthly basis, together with the

required information on industry reports.

• Candidate must be a graduate of any four (4) year course

• Must exhibit excellent sales aptitude, negotiation and presentation skills

• Must be self-motivated, independent and competitive

• Should have the ability to deal with different types of people

• Strong written and communication skills

• Highly proficient in Microsoft office

Accounts Officer – Corporate Intermediary Renewal Business

• 1. Conducts renewal negotiations with
• the Intermediary clients
•  

• 2. Evaluates, Analyses & Presents Utilization
• Report to Client periodically
• (Monthly, Quarterly, Semi-Annual, Annual)
•  

• 3. Conducts client’ healthcare needs
• analysis and provides solutions to clients’
• healthcare need:

• Candidate must be a graduate of any four (4) year course

• Must exhibit excellent sales aptitude, negotiation and presentation skills

• Must be self-motivated, independent and competitive

• Should have the ability to deal with different types of people

• Strong written and communication skills

• Highly proficient in Microsoft office

Finance Analyst

• General Accounting

1. 1. Maintains and updates schedules for
2. Accounts Payable, Miscellaneous Deposits,
3. Provider Deposits and other related accounts.
4.  

1. 2. Reconciles the accounts and recommends
2. adjusting entries as deemed necessary.

3. Monitors Disbursement’s application of

payment based on Unapplied Claims Reports.

• Candidate must be a graduate of Bachelor’s degree in  Accountancy

• Certified Public Accountant

• At least 1-year working experience in a related field is required in this position

• With effective written and oral communication and strong analytical skills

• Knowledgeable in Microsoft Excel

Inpatient Services – Roving Specialist

1. 1. Monitors hospital daily incurred running bills
2. and periodically updates the patient.
3.  

1. 2. Ensures adherence to given authority
2. limits and proper observance of
3. pre-defined policies and procedures

3. Negotiates initially balance billing

concerns otherwise elevate to

Roving Supervisor and/or

Provider Relations Officer (PRO)

• Candidate must be a graduate of Bachelor’s degree in Nursing or any medical allied course

• Willing to travel and work on extended hours

• Has good communication skills

• Must be able to work independently, possess a high sense of responsibility, good judgment, and decision-making skills.

• Proficient in Microsoft open office

Business Intelligence

& Product Management Officer

1. 1. Participate in all planning phase initiatives
2. such as research, FGD, and other
3. development requirements.
4.  
5.  

1. 2. Come up with scholarly product
2. recommendations responsive to market needs
3. and opportunities.
4.  

1. 3. Manage day-to-day progress of
2. product development, liaises with other
3. departments, and external parties involved.
4.  

1. 4. Develop and maintain the list of
2. market requirements for the product.

5. Extend direction and expertise to other departments and assist in product

function & service training.

• Graduate must be a graduate of Bachelor’s degree in Business Studies, Management, Marketing or any related course

• At least with 2 years’ experience in the related field is required doe this position

• Must have experience in Product Management

• Has good communication skills

Primary Care Center Customer

Care Specialist

– Out-Patient

Services

1. Assists the patients in their line-up via

the online queuing system.

1.  
2. 2. Thoroughly screens and assesses coverage
3. or non-coverage of availments.

1. 3. Encodes in the system manual LOAs
2. created while the member is availing
3. during unavoidable circumstances such as
4. system downtime, power failure, and calamities.

• Candidate must be a graduate of Bachelor’s degree in Nursing or any medical allied course

• Fresh graduates are welcome

• Willing to travel and work on extended hours

• Has good communication skills

• Willing to be assigned in Primary Care Clinics

Helpdesk

Customer

Care Specialist

– Out-Patient

Services

1. 1. Facilitates out-patient availments
2.  

1. 2. Assists the patients in their line-up via the online queuing system.

3. Thoroughly screens and assesses coverage or non-coverage of availments.

• Must be a graduate of Bachelor’s degree in Nursing or any medical allied course

• Fresh graduates are welcome

• Willing to travel and work on extended hours

• Has good communication skills

• Willing to be assigned in Primary Care Clinics

Medical Resource Specialist

1. 1. Answers medical inquiries from different units
2. or departments such as Contact Canter,
3. Clinic Operations & Outpatient Services,
4. Inpatient Services, Claims,
5. Actuarial and Underwriting,
6. Sales & Marketing.
7.  

1. 2. Recommends cases for approval
2. or disapproval based on expert
3. medical opinion, medical references
4. or journals, availment guidelines
5. and benefit plans.

3. Recommends professional fees of

affiliated physicians and instrument

fees based on Maxicare rates or

Relative Value Scale and existing

guidelines or benchmarked rates respectively.

• Must be a graduate of Medicine

• Preferably an Internal Medicine

• Must be willing to work full time

• Must be knowledgeable in Microsoft

Powerpoint, Excel, and Word

• Must be willing to work on extended hours

Medical Specialist – Corporate Utilization Management

1.  
2. 1. Analyses the periodic utilization data of
3. prioritized corporate accounts,
4. such as large, jumbo and super-jumbo
5. corporate accounts, and determines
6. the drivers of utilization costs,
7. top availers, type of availments,
8. top diseases and top providers.
9.  

1. 2. Formulates strategies and
2. recommendations to control and
3. decrease healthcare utilization costs of
4. the corporate accounts.

3. Consolidates both off-site and

on-site utilization review reports

from the annual check-Up (ACU),

Health & Wellness Unit and

Corporate Clinics Unit.

• Must be a graduate of Medicine

• Preferably a General Practitioner

• Must be willing to work full time

• Must be knowledgeable in Microsoft

Powerpoint, Excel, and Word

• Must be willing to work on extended hours

Mobile ACU Associate

1. 1. Facilitates the mobile annual check-up
2. of corporate accounts as follows:
3. (Refer to ACU Policies and Procedure)

1. 2. Decks and schedules the account
2. with a mobile ACU provider.

3. Conducts the pre-ACU meeting

with the ACU provider and corporate account.

• Must be a graduate of Bachelor’s degree in

Nursing or any medical allied course

• Fresh graduates are welcome

• Willing to travel and work on extended hours

• Has good communication skills

• Must be knowledgeable in Microsoft open office

Executive Check-up (ECU) Associate

1. 1. Assigns a suitable ECU provider for
2. the member after validation of
3. membership eligibility, ECU packages,
4. tests and procedures.
5.  

1. 2. Sends the confirmation letter to
2. the member within the turnaround
3. time of 24 hours upon receipt of the
4. ECU request form.
5.  

1. 3. Sends the letter of authorization (LOA)
2. to the ECU provider within the
3. turnaround time of two (2) days
4. prior to the scheduled date of ECU.

• Must be a graduate of Bachelor’s degree in

Nursing or any medical allied course

• Fresh graduates are welcome

• Willing to travel and work on extended hours

• Has good communication skills

• Must be knowledgeable in Microsoft open office

Provider Relations Manager – Visayas

1. 1. Strategizes and plans out tasks for all
2. PR Officers in his/her area.

1. 2. Troubleshoots problems, concerns, issues
2. and negative feedbacks coming from members,
3. providers, and doctors

1. 3. Analyses problems that run across
2. areas and provide accurate assessments
3. to come up with the appropriate solutions.

4. Evaluates and recommends

approval/disapproval of stale claims.

• Must be a graduate of Medicine

• Preferably a General Practitioner

• Must be willing to work full time

• Must be knowledgeable in Microsoft Powerpoint, Excel and Word

• Must be willing to work on extended hours

Supervisor – Provider Relations

1. 1. Evaluates the application of new providers
2. in terms of completeness and validity
3. of requirements.
4.  

1. 2. Performs ocular inspection of the provider facility.
2. Reviews the submitted proposal of rates.
3.  

1. 3. Drafts the contracts for new providers
2. as well as those for renewal.

4. Reports changes requested by the providers

to the management for approval.

• Must be a Graduate of BS Nursing or any medical allied course

• Willing to travel and work on extended hours

• Has good communication skills

• Has good presentation and negotiation skills

• Must be knowledgeable in Microsoft open office

Actuarial Assistant –Pricing and Quotation

1. 1. Processes compute and analyses
2. initial and revised quotation requests
3. from Sales and existing renewing accounts.
4.  

1. 2. Endorses to Supervisor processed
2. initial and revised quotation request
3. t for validation and approval.

3. Escalates for approval to higher

officer/s the quotations and benefits

beyond the limit of Supervisor

• Must be a graduate of Bachelor’s degree in Actuarial Science, Statistics or any related course

• With at least 1 year of relevant work experience

• With advance mathematical or financial
• aptitude, analytical and problem-solving skills

• HMO experience is an advantage

• Advance knowledge in MS Excel

Actuarial Supervisor – Pricing and Quotation

1. 1. Validates and checks computations
2. submitted by the Actuarial Assistant on
3. quotation requests.

1. 2. Analyses reviews and approves
2. quotations based on authorized limits.

2. Escalates to Assistant Manager or higher

officer quotation requests above and

beyond the authorized limits and other

actuarial concerns

• Must be a graduate of Bachelor’s degree in Actuarial Science, Statistics or any related course

• Has a strong background in creating, developing pricing models for new product

• HMO experience is an advantage

• Responsible in providing analytical and actuarial support services to the team