The Member Relations Representative (MRR) is responsible for providing effective and efficient administrative support to the Hospital Liaison Officers Department together with the rest of the departments of the Medical Services Division and the Sales and Marketing Division to insured members. They assist IHC members during their availments mainly and ensures the proper implementation of the “Magandang Araw” Customer Service Experience and ensuring the proper and appropriate implementation of plan policies resulting to utilization management.
DUTIES AND RESPONSIBILITIES:
This role will ensure that IHC members are assisted during their availment to contribute to employee engagement, and retention in proportion but not limited to the medical needs of the company and covered companies and individuals.
1. Customer Service
1.1. Ensure that IHC members availing of medical services in accredited medical facilities are assisted accordingly.1.2. Ensure that members’ queries, concerns and/or complaints are attended to in a timely and appropriate manner prior to elevating this to the Medical Director.1.3. Keep abreast with current regulations and policies affecting medical services and implementation and provide proper guidance to all concerned.1.4. Be up to date on medical updates, utilization management, newly onboarded and renewed account benefits.1.5. Maintain company spiels and lines that will entice members to call them regarding their benefit including medical network inquiries, concerns and LOA issuances.1.6. Ensure that the member’s coverage and benefits is discussed appropriately and issue the letter of authorization (LOA).1.7. Assist the member during their availment by checking medical facility charges and professional fee to maximize member’s benefits and to prevent incurrence of excess charges beyond the benefit coverage and advises member on non-covered charges.1.8. Issue LOAs and assist members for MD scheduling of appointments and other services.