1. Review of agreement benefit summary of corporate accounts & set-up of benefit plans

• Ability to read, analyze and interpret benefit plans and special concessions to ensure that our client’s plan requirements are properly setup within the core system.
• Coordinate with the Team Lead for review & sign-off of the benefit set-up to ensure accurate
  plan set-up in the system.
• Maintain the standard policies, procedures and turn-around-time (TATs) in benefit plan set-up
  for new accounts or update of the benefit plans for the renewal accounts to ensure the
  accuracy in processing and promptness.

2. Member enrollment and generation of billing statement

• Verify the membership eligibility and benefit packages based on Agreement Benefits Summary
  (ABS) before encoding/uploading of members to ensure the accuracy in member enrollment.
• Generate the initial bill for new accounts and ensure that number of members as well as applicable membership fees are as indicated in the ABS. Ensure to release accurate bill and according to agreed TAT.
• Monitors monthly renewing accounts and updates the renewal Agreement upon receipt of the renewal documents (Client’s conforme, ABS and renewal list) to ensure accuracy in processing.
• Generate the renewal bill and ensure to release accurate bill and according to agreed TAT.
• Schedule the updates of members including the additions, deletions and changes in the
  members profile and benefit plan to ensure the Client’s request are met on time.
• Review the Clients’ endorsement letter for cancellation of membership and ensure that it is
  based on the ABS prior to the deletion of members to ensure that there is no violation of
  contract provisions.
• Generate the appropriate bill for member additions and updates and release according to
  agreed TATs.
• Generate the succeeding modal bills and release according to agreed TATs.
• Tag billing and create AR and GL transmittal to ensures the Accounting Department will
  capture all billings on-time.
• Validate the members for enrollment to LGTI.
• Provide the details of members for endorsement of Dental coverage.

3. Centralized processing and validate issuance of membership kit

• Process the membership kits immediately after generating the bill and ensure that all new members will receive their membership cards accurately and on timely delivery.
• Provide a complete list of processed members, on-hold status and dis-qualified enrollees to the Client to ensure that all members are identified accurately.
• Communicate with the Account Executives / Agents / Brokers / Client the document or information needed through written form to assure accuracy in data encoding and/or completeness of requirements.
• Always observe and apply the rule of Data Privacy Act Law.

4. Membership fees accounts receivables collections and reconciliation of payments versus billings

• Maintain the basic accounting principles, practices and procedures to ensures that work is properly completed in a timely and accurate manner.
• Assist/Coordinate with Collections Specialist in reconciliation efforts for receivables/collections of corporate accounts.
• Provide billing details to the Client/Broker as needed/requested to aid in reconciliation of billings/collection.
• Generate and send out unpaid/balance membership fees letter to client-company to ensure that all communications are documented in coordination with Collections Specialist.

5. Computation and processing of unused membership fees, return of premium and excess payment (REFUND)

• Prepare and release the memo and letter to Client for refund of unused membership fees for deleted members, when applicable.
• Identify payments that need to be refunded, reconcile all billing transactions with excess payment and prepare all required documentation to ensure accurate processing of all transactions.
• Communicate with Client to resolve overpayment issues, when necessary.

6. Acknowledge emails especially coming from Sales/AMG and related to accounts that you are specifically handling. If the email was directed to you and you noted that you are not the one that is handling the account, acknowledge the email and include the person handling the account in your email reply for proper handling.

• Always make it a point to answer the call immediately or at least on the 2nd ring.
• When in a face-to-face meeting with someone at the time of call, excuse yourself for a moment
  and ask for permission from the person before you answer the call, get the name, number and
  concern of the caller and inform them that you are attending to another person at the moment
  and that you will call them as soon as you are done. Make sure to return the call.
• Always put your mobile phones on SILENT mode when in a meeting
• As we are mostly working from home and doing online meetings, please upload your profile picture to your account so that people can put a face to the name. Since this is a corporate - provided subscription please use a professional-looking photo.
• Do check your emails first thing at the start of your work as there may be emails that may need
  your immediate attention and/or response.
• Acknowledge emails especially coming from Sales/AMG and related to accounts that you are specifically handling. If the email was directed to you and you noted that you are not the one that is handling the account, acknowledge the email and include the person handling the account in your email reply for proper handling.
• Do make sure that you copy in the original person who sent the email when they refer a case to you. Easier to click the ‘reply all’ button than choosing individual recipients. Do not forget to delete or edit email addresses later if you feel that they should not be among the recipients of your email prior to sending the email.
• Always review your email prior to sending.
• When you have committed to provide a response/report on a specific concern make sure that you will revert to the person on the date/day committed. If information/data cannot be provided on the committed date/day, inform the person accordingly to manage expectations.

1. Acts as co-lead in dealing with provider groups for all medical practice matters. Developing
the best possible working relationships between iCare and its Accredited Providers (Doctors/Hospitals/Clinics/Wellness Partners)

• Ensures provider network meets strategic goals of managing utilization cost while
  providing high quality healthcare to members of iCare.
• Initiate, coordinate, attend meetings that relate to Provider credentialing and iCare’s
  compliance with regulatory requirements, etc.

2. Oversee the clinic management business/portfolio of iCare and ensure coordination with the
company clinics on utilization management initiatives and appropriate care implementation.

3. Provides when needed medical guidance and interpretation for all utilization management
issues (Prior Authorization, Concurrent Review, Retrospective Review)

• Guide the MSC and HLO team with the Pre-approval and concurrent review of cases
  for proper administration of benefits and appropriate care.
• Provide medical guidance in Claims adjudication as necessary.
• Conduct Utilization Review with specific accounts.
• Evaluation of appropriateness of medical care services utilized by the account
  members.

4. Provides when needed medical guidance and interpretation for all utilization management
issues (Prior Authorization, Concurrent Review, Retrospective Review)

• May function as the Lead Healthcare Professional to cover services including but not
  limited to answering medical/clinical inquiries both internal and external.

5. Co-manage the Medical Provider and Services Division, which may include but is not limited to
interviewing and selection, goal setting, and coaching of staff.

6. Participate and lead in appropriate healthcare programs for clients as necessary.

• Creation of preventive health programs in the corporate setting based on the profile of
  the clients.
• Oversee the implementation and management of the Chronic Disease Management
  Program, Sleep Better Program and other health and wellness initiatives of iCare.

1. Design and Develop Solutions

• Participate in requirements gathering, systems analysis and design
  process.
• Analyze business and technical requirements and prepare system
  design specifications.
• Design and code efficient information system solutions.
• Test, debug and correct system errors or faults.

2. Solutions Deployment and Maintenance

• Ensure proper deployment of the application.
• Investigate and address system bugs/ issues in a timely manner.

3. Mentoring

• To provide guidance to junior analyst programmer and colleagues in terms of programming structures, methodologies and techniques.

1. Claims Reimbursement payable processing (target 40/day)

a. To achieve 100% accurate payable processing based on set targets. Payable
processing should be within 1 day turnaround time and zero backlog.
b. Checks and review the supporting documents of all medical claims submitted by
Claims Department.
c. Checks and review claims details transmitted in SAP.

d. Update and edit the lacking information in the system such as cost center, account,
accounting received date and remarks.
e. Check, Review and analyze Journal Entries in SAP.
f. Request Update of Account Creation and Tax update to approver
g. Update the tax tagging in SAP (VAT and Withholding tax).
h. Ensures that the PCL is signed by the authorized signatory and reviewed by the

Medical Auditor

i. Coordinate to claims unit for discrepancy of amount and information.
j. Send email for AP Invoice system approval to the approver.
k. Post Approved AP invoice for payment.
l. Forward AP claims Document to Disbursement Team for Fund Transfer Preparation.

2. Compliance

• 100% accurate computation VAT and Withholding Taxes on all payable processing
  transactions.
• Ensure all payables transactions are fully supported with documents particularly on Billing

3. Customer Service

• Oversee 100% CMT tickets are responded within turnaround time.
• To promptly respond to inquiries through phone, emails and teams chat to employees and service providers.

4. Filing and Organization

• To keep critical documents, such as original copies of claims documents, AP
  Voucher and properly sort and file such documents in an organized manner,
  keeping these documents in a safe and protected area.

5. Others'

• Assist System Process improvement UAT.
• Assist BIR audit submission of supporting documents.
• Assist External and Internal Audit submission of supporting documents.

Renewal of Account

1.1 Reviews health profile and utilization of existing corporate accounts on a semi-annual basis or
annual to check financial risk and recommends intervention when indicated.
1.2 Provide renewal offer to the account two (2) months prior to expiration to give ample time for
negotiation.
1.3 Provides and recommends program enhancement based on the review of the account’s health
profile.
1.4 Coordinates with actuarial regarding pricing and other units of Insular Health Care for the
requirements of the account.

After Sales

2.1 Conducts after sales orientation to ensure that clients understand their benefits and availment
procedure.
2.2 Does account visitation at least three (3) times a year to build rapport and to develop a positive
working relationship with the account.
2.3 Prepares the necessary documents to be routed to different units of Insular Health Care for
proper endorsement of account.
2.4 Serves as a channel between clients and other units of Insular Health Care

Upsell

3.1 Offers enhancement of benefits to the account (i.g. inclusion of dependents coverage, dental,
upgrade of plan)
3.2 Visits and provides proposal for accounts that did not renew within one (1) year from the date
of termination of contract or non-renewal

For Pooling

• Bachelor of Science in Psychology, Human Resources, Industrial Relations or a related field
• Managing employee and labor relations, ensuring compliance with employment legislation and negotiating collective agreements.
• Ensures proper handling of Employee Disciplinary Actions.
• Develops HR policies aligned with hospital objectives and government legislations.

• Bachelor of Science in Business Administration, Marketing, or any sales/business-related courses
• Performance Monitoring and Data Analytics
• Revenue Optimization
• Market Analysis
• Product/Service Development Support

• Bachelor of Science in Mass Communication, Communication, Advertising, Business Administration, Marketing Management or any business, marketing, communication related courses.
• Collaborate with management to develop and implement an effective communications strategy based on our target audience.
• Write, edit, and distribute content, including publications, press releases, website content, annual reports, speeches, and other marketing material that communicates the organization's activities, products and/or services.
• Respond to media inquiries, arrange interviews, and act as a spokesperson for the organization.
• Establish and maintain effective relationships with journalists, and maintain a media database.
• Seek opportunities to enhance the reputation of the brand, and coordinate publicity events as required.
• Maintain records of media coverage and collate analytics and metrics.

• Bachelor's Degree in Business Studies, Administration, Management, Commerce, Marketing, or equivalent.
• The Accounts Officer serves as the primary business contact for internal and external clients to encourage new and repeat business opportunities.
• Responsible for achieving maximum sales profitability, growth and account penetration within the assigned market segment.
• Develop business plans and strategies that expands Hospital’s customer base for the assigned account.

• Bachelor of Science in Medical Technology
• Perform standard phlebotomy technique and collect blood samples, swabs and other samples from patients.
• Practice proper labelling of all samples.
• Transport all specimens.
• Provides medical technology information by answering questions and requests.
• Maintains safe and clean working environment by complying with procedures, rules, and regulations.
• Protects patients and employees by adhering to infection-control and hazardous waste policies and protocols; following identification procedures.
• Maintains patient confidence and protects the hospital by keeping information confidential.

• Bachelor of Science in Pharmacy
• Handle releasing of drugs at the front-end area of the pharmacy for both outpatient and inpatient customers.
• Ensure efficiency in the dispensary area of the pharmacy.
• Manage the inventory or monitoring of all supplies of the pharmacy.
• In-charge of the Pharmacy Inventory database who monitors all generics or brands, expiry and batch codes.

• Bachelor of Science in Nursing
• Responsible for maintaining and/or improving the health status of employees.
• Promote optimum health status and lifestyles for all employees through the joint efforts of the management and the Wellness Center.
• Promote patient safety and support all related programs and policies to ensure the delivery of excellent patient care.

• Bachelor of Science in Nursing
• Manage individualized, goal-directed nursing care through use of the nursing process and the principles of primary nursing in accordance with departmental and hospital policies and procedures.
• Promote patient safety and support all related programs and policies to ensure delivery of excellent patient care.

• At least 18 years old
• Excellent English communication skills
• Senior High School or High School Graduate
• Answers and initiates a variety of real-time inbound and outbound voice and non-voice based services.
• Verifies and updates customer information, responds to queries and resolves issues.