Job Description

1. Customer Service
   1.1 Acts as reliever for Member Relations Representatives (MRR) deployed in identified clients.
2. Utilization Management
   2.1. Ensures proper gatekeeping and utilization management through:
3. Determination of validity of the member status, benefit coverage and maximum available limit prior issuance of LOAs through information garnered from the Medical Account System (MAS).
4. Review of cases and checking necessity of availment and need for medical procedure.
5. Coordination of catastrophic cases to superior for case management.
6. Relationship Management
   3.1 Builds and maintains good rapport with iCare’s designated Hospital Care Director (HCD) in the hospital, iCare’s roster of accredited physicians and provider personnel.
   3.2 Assists the Provider Management Division by:
   3.3 Increasing the roster of accredited medical facilities especially physicians.
   3.4. Do on the spot or provisional accreditation of member accessed/requested physicians and/or medical facilities.
   3.5. Updating the records of physicians as the need arises.
   3.6 . Conducting orientation/ re-orientation of Accredited Providers.