JOB TITLE |
WORK SCOPE |
CREDENTIALS |
Company Nurse |
- 1. Renders basic nursing care such as,
- first-aid treatment, wound dressing, etc.
-
- 2. Conducts initial medical assessment of
- members through vital signs-taking prior
- to actual consultation with the Retainer Physician.
-
3. Assists the Corporate Retainer Physician
when performing a physical examination.
- 4. Monitors and maintains records of
- daily consultations and work clearances.
-
- 5. Dispenses over-the-counter medicines
- provided by the account.
-
|
- 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. Facilitates member’s availment
-
- 2. Screens and assess coverage or
- non-coverage of availment (for
- readily-coverage or non-coverage cases.)
-
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
|
Workforce Analyst |
- 1. Utilizes staffing models for new or adjusted
- forecasted assumptions.
- 2. Perform analysis to validate the process
- compliance and provide trend and/early
- 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
|
Accounts Officer – Consumer Luzon Renewal Business Intermediary/Direct |
- 1. Generates/expands sales revenues
- from an existing portfolio of accounts
- (renewal business) and manages
- the accounts to ensure customer retention.
-
- 2. Achieves the sales target based on
- 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. Generates leads through Cold calls, Referral, and Saturation per Area assigned.
- 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. Manages consumer and corporate account
- to ensure its renewal to achieve set sales target.
-
- 2. Ensures that the terms & conditions
- of the contract of the client are properly
- & 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. Achieves 100% of assigned business target
-
- 2. Submits and provides baseline
- information on industries assigned.
-
- 3. Provides client information and updates
- & 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
|
- 1. Maintains and updates schedules for
- Accounts Payable, Miscellaneous Deposits,
- Provider Deposits and other related accounts.
-
- 2. Reconciles the accounts and recommends
- 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. Monitors hospital daily incurred running bills
- and periodically updates the patient.
-
- 2. Ensures adherence to given authority
- limits and proper observance of
- 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. Participate in all planning phase initiatives
- such as research, FGD, and other
- development requirements.
-
-
- 2. Come up with scholarly product
- recommendations responsive to market needs
- and opportunities.
-
- 3. Manage day-to-day progress of
- product development, liaises with other
- departments, and external parties involved.
-
- 4. Develop and maintain the list of
- 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.
-
- 2. Thoroughly screens and assesses coverage
- or non-coverage of availments.
- 3. Encodes in the system manual LOAs
- created while the member is availing
- during unavoidable circumstances such as
- 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. Facilitates out-patient availments
-
- 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. Answers medical inquiries from different units
- or departments such as Contact Canter,
- Clinic Operations & Outpatient Services,
- Inpatient Services, Claims,
- Actuarial and Underwriting,
- Sales & Marketing.
-
- 2. Recommends cases for approval
- or disapproval based on expert
- medical opinion, medical references
- or journals, availment guidelines
- 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. Analyses the periodic utilization data of
- prioritized corporate accounts,
- such as large, jumbo and super-jumbo
- corporate accounts, and determines
- the drivers of utilization costs,
- top availers, type of availments,
- top diseases and top providers.
-
- 2. Formulates strategies and
- recommendations to control and
- decrease healthcare utilization costs of
- 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. Facilitates the mobile annual check-up
- of corporate accounts as follows:
- (Refer to ACU Policies and Procedure)
- 2. Decks and schedules the account
- 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. Assigns a suitable ECU provider for
- the member after validation of
- membership eligibility, ECU packages,
- tests and procedures.
-
- 2. Sends the confirmation letter to
- the member within the turnaround
- time of 24 hours upon receipt of the
- ECU request form.
-
- 3. Sends the letter of authorization (LOA)
- to the ECU provider within the
- turnaround time of two (2) days
- 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. Strategizes and plans out tasks for all
- PR Officers in his/her area.
- 2. Troubleshoots problems, concerns, issues
- and negative feedbacks coming from members,
- providers, and doctors
- 3. Analyses problems that run across
- areas and provide accurate assessments
- 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. Evaluates the application of new providers
- in terms of completeness and validity
- of requirements.
-
- 2. Performs ocular inspection of the provider facility.
- Reviews the submitted proposal of rates.
-
- 3. Drafts the contracts for new providers
- 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. Processes compute and analyses
- initial and revised quotation requests
- from Sales and existing renewing accounts.
-
- 2. Endorses to Supervisor processed
- initial and revised quotation request
- 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. Validates and checks computations
- submitted by the Actuarial Assistant on
- quotation requests.
- 2. Analyses reviews and approves
- 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
|