10 jobs in Maxicare Healthcare Corporation

Job Title: Provider Services Assistant Manager
Level: Assistant Manager
Reporting Line: Provider Services Manager
Customer Type: Maxicare Providers
Position Accountability Statement
The Provider Services Assistant Manager is accountable for direct management of the InHouse team

and/or overseeing the Outsourced Partners to drive performance to achieve the organizational goals. This

position will have complete ownership of programs and accountability for operational, financial and

customer results.

Broad Responsibility InHouse Assistant Manager

• Provides critical input to strategy development and ensures the operational implementation and execution is aligned with the overall Department strategy including formation of goals, priorities, action plans and communication to ensure total organizational alignment.
• Develops and manages the process for evaluating Team performance, needs assessment, spend optimization and risk management.
• Evaluate the overall performance of the assigned Team and provide insights to further improve the performance.
• Manages and review the day-to-day activities of the assigned Team
• Provides immediate coaching and regular feedback to assigned Team members.
• Handles and manages all types of escalations from designated team or unit prior to hand off and escalation to dependencies, as appropriate & applicable (i.e. Medical, PNM, UEF, Sales, Ops), enables collaboration and ensures action for case resolution and service recovery
• Submits accurate, timely, and complete reports (metrics of team performance or any report as deemed necessary).
• Reviews and contributes in updating work processes, policies, procedures, work instructions, workflow, and other documentation as may be required in compliance to existing ISO Certification standards.
• Ensures team members are updated on the policies and procedures and complying with company standards.
• Performs other related duties and tasks assigned by the Immediate Head.

Desired Skills And Competencies

• Leadership and Customer Service Orientation: Ability to inspire and motivate teams while delivering exceptional service and promoting organizational benefits.
• Strong Communication and Escalation Management: Excellent verbal and written communication skills, adept at clarifying issues and effectively escalating complex cases.
• Performance Management: Experience in overseeing team performance, providing feedback, and conducting performance reviews.
• Training and Development Facilitation: Skilled in enhancing team skills through training, mentoring, and facilitating orientation sessions.
• Documentation and Operational Workflow Management: Detail-oriented with experience in managing operational workflows and updating process documentation.
• Adaptability and Ethical Standards: Flexible in adjusting to changing circumstances while maintaining patient confidentiality and adhering to ethical practices.

Professional Qualification

• Graduate of any 4-year course with at least 3 years of experience in Customer Care.
• Knowledge of industry standards (e.g., ISO standards) and regulatory compliance requirements, with the ability to ensure adherence to company policies and guidelines

Role: PROVIDER SERVICES SUPERVISOR - E2E (IC)
Level: Supervisor (Blended/Hybrid Role)
Reporting Line: Provider Services Assistant Manager
Customer Type: Maxicare Providers and Members
Position Accountability Statement
The Supervisor plays a critical role in ensuring the smooth functioning of the overall Inpatient Team and has a direct impact on the efficiency of the overall Inpatient Team's processes. This will improve service delivery, uphold the quality and reliability of our services for Maxicare members, and support our Partner Providers.

Responsibility Highlights
The following broad responsibility statements are representative of the basic expectations about the role or function. Depending on business needs and exigencies, these responsibility statements may be modified. Critical to any leadership function is the need to demonstrate flexibility and agility in adapting to the changing requirements of the business.

• Minimal to zero supervision to review, evaluate, and process Letters of Authorization (LOA) following established procedures and professionally explain coverage and non-coverage details during Member's Availment Guide (MAG) discussion with admitted members.
• Analyze escalations and address concerns related to internal and external partners regarding eligibility, coverage (professional fees, miscellaneous &, etc.), and procedures within the standard turn-around time.
• Offer first-hand solutions for captured complaints and endorse them to internal departments (MRG, UEF, Sales) as necessary.
• Offer and steer members to the Maxicare Primary Care Networks, Preferred Partners, and Low-Cost Facilities, while highlighting Maxicare's exclusive benefits including recommended packages, and assisting members in understanding the available services.
• Works directly with the immediate superior in meeting the team and company's common goal. Prepare and submit reports ensuring that data is accurate and comprehensive.
• Execute various campaigns and tasks as needed during manpower shortages, business continuity planning (BCP) events, or when Service Level (SL) for other teams or sub-units are critically low, ensuring operations remain smooth and responsive to immediate demands.

Desired Skills And Competencies

• Strong Communication Skills: Strong verbal and written communication skills to explain coverage, handle inquiries, and liaise with various stakeholders effectively.
• Customer Service Oriented: Focus on providing excellent service, including handling inquiries and complaints with professionalism and empathy. Understanding Maxicare products and account's benefits and coverages.
• Problem-Solving Abilities: Capacity to assess situations and escalate complex cases appropriately, while providing first-hand solutions when possible.
• Organizational Skills and Technical Proficiency: Proficiency in managing multiple tasks, prioritizing effectively, and ensuring accurate documentation and filing of transactions. Experience with CRM systems (like Salesforce) and telephony systems (like Genesys) for managing customer interactions.
• Adaptability: Willingness to adjust to changing circumstances, especially during business continuity planning or manpower shortages.
• Confidentiality and Ethics: Commitment to maintaining patient confidentiality and adhering to ethical standards in all operations.

Professional Qualification

• A Bachelor's degree in a Healthcare or Medical-related field is preferred. Alternatively, candidates with at least 3 years of college education with a minimum of 2 years experience in Customer Service, or work experience in the medical field.
• Excellent verbal and written communication skills.
• Proficient in data entry and transaction processing with attention to detail.
• Proficient in using Google Applications (Gmail, GSheets, GSlides & etc.).

Role: PROVIDER SERVICES ASSISTANT MANAGER - CUSTOMER ENGAGEMENT
Level: Assistant Manager
Reporting Line: Provider Services Manager
Customer Type: Maxicare Providers and Members
Position Accountability Statement
The Provider Services Assistant Manager-Customer Engagement is accountable for the direct management of the

Customer Engagement team to drive performance to achieve the organizational goals. This position will have

complete ownership of programs and accountability for operational, financial, and customer results.

Broad Responsibility Highlights
The following broad responsibility statements are representative of the basic expectations about the role or

function. Depending on business needs and exigencies, these responsibility statements may be modified. Critical

to any leadership function is the need to demonstrate flexibility and agility in adapting to the changing

requirements of the business.

• Provides critical input to strategy development and ensures the operational implementation and execution is

aligned with the overall Department strategy including formation of goals, priorities, action plans and

communication to ensure total organizational alignment.

• Leads the evaluation of team performance, conducts needs assessments, and implements initiatives for

optimization and risk management. Encourages a positive, collaborative work environment and fosters open

communication across the team.

• Manage day-to-day activities, ensuring workflow efficiency and addressing issues as they arise. Compiles and

delivers accurate, timely reports on team performance and strategic goals, identifying trends and opportunities

for improvement.

• Provides continuous feedback, coaching, and mentoring to team members. Collaborate with the Support Services

team (Learning & Development, Quality Assurance, & etc.) to enhance individual and team skills, driving

continuous improvement and performance growth.

• Collaborates with internal and external stakeholders to facilitate issue resolution and service recovery.
• Reviews and contributes in updating work processes, policies, procedures, work instructions, workflow, and other

documentation as may be required in compliance to existing ISO Certification standards. Ensures team members

are updated on the policies and procedures and complying with company standards.

• Develop and maintain a strong provider-partner relationship by regularly communicating with providers,

understanding their needs and concerns, ensuring alignment with company policies and objectives

• Execute various campaigns and tasks as needed during manpower shortages, business continuity planning (BCP)

events, or when Service Level (SL) for other teams or sub-units are critically low, ensuring operations remain

smooth and responsive to immediate demands.

Desired Skills And Competencies

• Leadership and Customer Service Orientation: Ability to inspire and motivate teams while delivering

exceptional service and promoting organizational benefits.

• Strong Communication and Escalation Management: Excellent verbal and written communication skills,

adept at clarifying issues and effectively escalating complex cases.

• Performance Management: Experience in overseeing team performance, providing feedback, and

conducting performance reviews.

• Training and Development Facilitation: Skilled in enhancing team skills through training, mentoring, and

facilitating orientation sessions.

• Documentation and Operational Workflow Management: Detail-oriented with experience in managing

operational workflows and updating process documentation.

• Adaptability and Ethical Standards: Flexible in adjusting to changing circumstances while maintaining

patient confidentiality and adhering to ethical practices.

Professional Qualifications

• Bachelor's degree in a medical-related field or with a minimum of 3-5 years of relevant healthcare

Experience

• Proven leadership abilities, with experience creating a collaborative work environment and driving

effective cross-functional communication.

• Excellent Performance management skills
• Knowledge of relevant industry regulations, compliance standards, and best practices in quality

management and the ability to ensure adherence to company policies and guidelines as advantage.

• Proficient in data entry and transaction processing with attention to detail.
• Proficient in using Google Applications (Gmail, GSheets, GSlides & etc.).

Job Title: Liaison Officer
Department: Operations Fulfillment
Division: Operations Division
Reports to (Position of Immediate Superior) : Supervisor, Inpatient Services
Supervises (Positions of Subordinates) : None
Primary Job Responsibility
Accountable for accurately implementing the members' healthcare benefit policies and the delivery of superior customer services for In-Patients

I.job Description
Duties and Responsibilities done at PERIODIC or REGULAR Intervals

• Monitors, assesses and evaluates members' availment of services based on stipulated coverage of the account while obtaining, collecting, collating, processing and reviewing all patient data information from the attending doctors, nurses, patients, charts and other sources of information necessary in adjudicating coverag e
• Visits, revisits, contacts, discusses and ensures that inpatient members understand the limits and scope of their insurance benefits
• Creates, reviews, approves or disapproves, issues and updates Letter of Authorization according to approved authority limits
• Monitors and updates billing of member as necessary, analyzes and computes for possible excess charges that may be incurred by members if applicable and endorses coverage to provider accordingly

B.Duties And Responsibilities Done At IRREGULAR Or INTERMITTENT Intervals

• Coordinates and establishes rapport with affiliated doctors and hospital staff & attends scheduled meetings
• Reviews, resolves, escalates and responds to queries on members' availing of services
• Reviews and reports concerns of affiliated doctors and hospital staff to the Immediate Superior

C.STANDARD RESPONSIBILITY STATEMENTS

• Strives to embody, commits to support and deliver the Management System policy, objectives and initiatives of the organization;
• Communicates, engages, directs and supports people to contribute to the Management System effectiveness;
• Demonstrates commitment to customers by ensuring applicable statutory and regulatory requirements are determined, understood and consistently met;
• Abides by the Management System policies and procedures for the effective management and control of its processes; and
• Promotes and utilizes the Process Approach and Risk-based Thinking at work.
• Performs other RELATED functions that may be assigned BY THE IMMEDIATE SUPERIOR

II.JOB SPECIFICATIONS A. SKILLS 1. EDUCATIONAL REQUIREMENT
MINIMUM educational level and background required by this POSITION: College Graduate of 4, 5 year-course, preferably: Allied Medical Course
2. EXPERIENCE AND TRAINING
PERIOD OF TIME OR LENGTH of related experience the CANDIDATE must acquire before being assigned to and perform the functions of this job,

SATISFACTORILY under NORMAL supervision: Fresh Graduate - Less than 3 years

• SKILLS REQUIREMENT – TECHNICAL (For Tech and Business Support, Supervisory and Professional) Skilled or specialized: proficiency is gained thru wide experience in a SPECIALIZED or TECHNICAL area B. RESPONSIBILITY 1.ACCOUNTABILITY – ASSETS, CASH, EQUIPMENT Value or worth of company assets (cash, checks, financial instruments, investments, tools, materials, machinery, equipment, and supplies) this POSITION is accountable for: Small - below P500, 000 SPECIFY ASSETS, CASH AND EQUIPMENT DIRECTLY ACCOUNTED FOR: Tablet, Mobile Phone 2.ACCOUNTABILITY – RECORDS AND DOCUMENTS Level of CONFIDENTIALITY AND IMPORTANCE of the information, records, reports, and documents prepared, maintained, has access to, and handled by this POSITION Routinely, Low - Contents are of general nature; knowledge by others is NOT INIMICAL; disclosure may not have apparent effect on the company

RECORDS AND DOCUMENTS DIRECTLY ACCOUNTED FOR: Shared Documents
3.NEED FOR SUPERVISION
EXTENT of work supervised or managed by the Immediate Superior, whether the job is limited or diversified; quantify range of activities, VARIETY of tasks to be carried out, and the DIVERSITY of the problem to be solved Follows established procedures generally; refer only unusual cases to superior
4.PEOPLE MANAGEMENT
Number of subordinates this POSITION DIRECTLY supervise: None
5.CONTACTS – INTERNAL AND EXTERNAL
EXTENT the work required in making personal contacts inside and outside of the organization, level of importance of contacts; FREQUENCY they are made; LEVEL OR DEGREE they involve exchanging information, dealing with people, exerting influence, persuading them to take action, etc. Broad, Significant

C. EFFORT 1.PHYSICAL EFFORT
USUAL POSITION at work of this JOB considering energy needed and exerted to satisfactorily perform the job Standing is done most part of the day
2.MENTAL EFFORT
AMOUNT OF THINKING to analyze problems; develop and evaluate solutions to given problems Patterned - Requires a PLAIN understanding of PROGRAMMED steps to arrive at solution; with similar situations requiring solution by only discriminating choice of learned things

D. WORK CONDITIONS 1.JOB ENVIRONMENT
STATE of surrounding and physical conditions under which the JOB must be satisfactorily accomplished Comfortable MOST OF THE TIME in an: Air-conditioned, well-lighted, clean, quiet, conducive room
2.SAFETY AND EXPOSURE TO HAZARDS, RISKS, DANGER
Hazards, risks or danger POSITION is exposed to in job performance, DESPITE safety measures provided Exposure to few disagreeable elements is less than 25% of the time

SUPERVISOR - MEMBER SERVICES
Level: Supervisor
Reporting Line:
Asst. Manager - Member Services/ Manager - Member Services

Customer Type:
Maxicare Members

Position Accountability Statement
The Inhouse Representative is responsible for handling inbound calls from customers, particularly those related to concerns or appointment scheduling at our Primary Care Clinic. This role requires providing exceptional customer service, addressing inquiries or issues promptly and efficiently, and ensuring alignment with the organization's service standards and goals.

Broad Responsibility Highlights
Customer Service:

• Assisting to book an appointment in our PCC
• Providing assistance in follow up in their laboratory result.
• Handles inbound calls from customers, addressing inquiries, complaints, and requests in a professional manner.
• Provides accurate information regarding products, services, policies, and procedures.
• Escalates complex issues to the appropriate department or supervisor when necessary.

Call Management

• Manages call volume efficiently, ensuring timely responses to customer inquiries.
• Follows standard operating procedures for call handling and documentation.
• Logs and updates customer interactions in the system as required.
• Adheres to call scripts and processes to maintain consistency and quality.

Performance Monitoring

• Meets or exceeds individual performance targets, including average handle time (AHT), call resolution rates, and customer satisfaction scores (CSAT).
• Receives regular feedback and coaching to improve performance and customer service skills.
• Utilizes key performance indicators (KPIs) to track and monitor performance.

Problem Resolution

• Provides timely and effective resolutions for customer concerns or issues.
• Identifies customer needs and offers suitable solutions to enhance satisfaction.
• Demonstrates active listening and empathy when handling customer complaints or challenging situations.

Communication

• Communicates clearly and professionally with customers, colleagues, and supervisors.
• Escalates issues to higher management or departments when necessary for further assistance.
• Maintains effective communication and collaboration with team members and leadership.

Adherence To Policies

• Ensures compliance with company policies, procedures, and quality standards.
• Follows data protection guidelines to safeguard customer information.
• Maintains knowledge of the latest updates on services, products, and procedures.

Reporting And Documentation

• Accurately records and documents customer interactions, including complaints, inquiries, and resolutions.
• Submits daily/weekly performance reports, including call logs and customer feedback.

Team Collaboration

• Collaborates with team members and other departments to ensure smooth operations and customer service delivery.
• Participates in team meetings and shares insights to improve team performance.

Motivation And Morale

• Contributes to a positive and energetic work environment by maintaining a professional attitude.
• Actively engages in team-building activities and supports a cooperative team dynamic.

Desired Skills And Competencies

• Customer-Centric Approach
• Effective Communication Skills
• Problem Solving
• Time Management
• Attention to Detail
• Patience and Empathy

ER CARE NAVIGATOR
Level: Supervisor
Leadership Responsibility: Individual Contributor
Reporting Line: Head - Provider Services, Customer Care
Position Accountability Statement
The ER Care Navigator, is responsible for ensuring efficient utilization of emergency room (ER) resources

by collaborating with hospital ER staff to assess case urgency, managing LOA issuance and redirection

when appropriate, addressing inquiries and concerns related to ER services, delivering clear explanations

of benefits to members, and supporting steerage and primary care network (PCN) initiatives to enhance

healthcare efficiency and member experience.

Broad Responsibility Highlights
The following broad responsibility statements are representative of the basic expectations about the role

or function. Depending on business needs and exigencies, these responsibility statements may be

modified. Critical to any leadership function is the need to demonstrate flexibility and agility in adapting to

the changing requirements of the business.

• Support members by collaborating with hospital ER staff to assess case urgency, ensuring that

only qualified emergency cases, whether Outpatient or In-patient, are directed to the Emergency

Room. This involves coordinating with healthcare professionals to prioritize critical cases, and

allocating resources for timely and effective care. The focus on prioritizing emergency cases aims

to optimize ER efficiency and improve patient outcomes.

• Provide assistance to members during Emergency Room (ER) visits by efficient/ timely issuance

of Letters of Authorization (LOA) to facilitate access to medical services. Implement redirection

strategies as needed to direct non-emergency cases to alternative healthcare facilities or

services. This includes offering guidance on available healthcare options, and ensuring smooth

transitions to optimize the suitability and efficiency of care delivery.

• Handle various concerns and inquiries related to Emergency Room (ER) availment and

miscellaneous items. Provide assistance and clarification to members on ER services, eligibility,

coverage, and procedures. By effectively addressing these concerns, ensure members are

well-informed and supported, contributing to a positive patient experience and optimal ER

resource utilization.

• Facilitate seamless transitions for patients from the Emergency Room (ER) to the Inpatient Team

by endorsing cases for admission. Collaborate with healthcare professionals to assess patient

needs, compile required documentation, and communicate relevant information to the Inpatient

Team. Ensure timely and appropriate care upon admission, promoting continuity of care and

optimal patient outcomes.

• Provide detailed explanations of benefits and review coverage and non-coverage based on their

benefit provision. Additionally, offer direct assistance to members who are unaccompanied,

addressing any questions or concerns they may have, ensuring they receive the necessary

support and understanding.

• Promotion and Steerage to our Primary Care Networks. Encourage and assist members in

visiting our Primary Care Networks (PCNs), providing full support and guidance. This includes

advocating for PCN benefits and helping members understand available services.

• Act as gatekeeper and screen for unnecessary charges in accordance with our memo. This

involves carefully reviewing charges and expenses to ensure compliance with established

guidelines and protocols. By diligently fulfilling this role, we aim to prevent unnecessary costs and

uphold financial accountability within the organization.

• Enhance cost savings by directing non-emergency cases to more suitable healthcare services or

facilities. This includes evaluating case urgency and guiding individuals towards alternative care

options. Through this approach, we strive to maximize resource utilization, reduce unnecessary

expenses, and promote overall efficiency and financial sustainability within the organization.

Desired Skills And Competencies

• Effective Prioritization and Timely Decision Making: Ability to prioritize tasks efficiently and

make timely decisions to address issues promptly.

• Assertive Negotiation and Influencing Skills: Capability to negotiate effectively and influence

Maxicare business results positively.

• Concise Communication: Skill in conveying information clearly and succinctly to ensure

effective communication.

• Conflict Resolution and Interdisciplinary Collaboration: Proficiency in resolving conflicts and

collaborating with interdisciplinary teams to achieve common goals.

• Efficient and Proactive Customer Service: Capacity to provide proactive and personalized

customer service efficiently, demonstrating empathy and active listening.

• In-Depth Knowledge on Products, Policies, and Procedures: Thorough understanding of

Maxicare products, policies, and procedures, with attention to detail and a willingness to share

knowledge.

• Critical Thinking and Critical Decision-Making: Ability to think critically and make sound

decisions based on thorough analysis and evaluation.

• Adaptability and Independent Decision-Making: Flexibility to adapt to changing circumstances

and make independent decisions as needed.

• Empathetic Communication and Influencing Skills: Ability to communicate empathetically and

influence stakeholders effectively to achieve desired outcomes.

Professional Qualification

• Preferably with at least 5 years experience in a customer service role
• Preferred industry orientation: Healthcare, Insurance, Pharmaceuticals, FMCG, or any service-oriented industry

EDUCATIONAL REQUIREMENT

College Graduate of 4, 5 year-course, preferably: Medical Allied Courses

Experience And Training
at least 6 months hospital experience is an advantage but may not be required

Skills Requirement
Skilled or specialized: proficiency is gained thru wide experience in a SPECIALIZED or TECHNICAL area

Job Responsibilities

• Gathers data and encodes the information necessary to complete the invoice in SAP to be validated by the immediate superior. Prints confirmed Invoice/s and letter and emails to Clients
• Analyzes and computes for unused portion of the premium and endorses to SAP for canceled account
• Gathers data, analyzes and prepares Credit Memo for Clients; and sends through email or via courier
• Collates data, analyzes and ensures accurate and timely reconciliation of system-generated data against data from SAP per cut-off schedule of all Full Risk (FR) accounts; in case of discrepancies, coordinates with SAP and updates internal excel file

Educational Attainment

• College Graduate of 4, 5 year-course, preferably: BSBA Accountancy or Related Course

Experience and Training

• With 1 year experience in customer service handling the same position

Skills Requirements

• Must be a computer literate
• Excellent communication skills both oral and written

Job Title: Account Management Specialist

Division: Customer Care

Department: Account Services

Reports to (Position of Immediate Superior) : Account Management Officer

Primary Job Responsibility

• Accountable for providing administrative assistance and support to the various requirements of the Sales Team, Direct Clients, Agents, and Brokers

I.job Description

• Duties and Responsibilities done at PERIODIC or REGULAR Intervals

Collaborates and liaises any Customer requests to concerned parties to ensure timely completion of Account Management Support

Provides administrative support to Sales Team, Direct Clients, Agents and Brokers

Collates data, prepares and submits weekly Monitoring Reports to Immediate Superior regarding concerns and other transactions endorsed by the Sales Team, Direct Clients, Agents and Brokers

Responds to inquiries from Direct Clients, Agents and Brokers, collaborates with concerned Department on these inquiries

• Duties and Responsibilities done at IRREGULAR or INTERMITTENT Intervals

Monitors and ensures accurate and timely feedback of account deliverables such as; ID Cards, Claims reimbursements, membership enrollment updates.

Handles daily transactions received from various touch points and ensures requests are properly attended to.

Coordinates with various departments to resolve general; queries, concerns and complaints.

• STANDARD RESPONSIBILITY STATEMENTS

Strives to embody, commits to support and deliver the quality policy, objectives and initiatives of the organization;

Communicates, engages, directs and supports people to contribute to the QMS effectiveness;

Demonstrates commitment to customers by ensuring applicable statutory and regulatory requirements are determined, understood and consistently met;

Abides by the QMS policies and procedures for the effective management and control of its processes; and

Promotes and utilizes the Process Approach and Risk-based Thinking at work.

Performs other RELATED functions that may be assigned BY THE IMMEDIATE SUPERIOR

II.JOB SPECIFICATIONS

• SKILLS
• EDUCATIONAL REQUIREMENT

MINIMUM Educational Level And Background Required By This POSITION
College Graduate of 4, 5 year-course, preferably: Business Related Courses

• EXPERIENCE AND TRAINING

PERIOD OF TIME OR LENGTH of related experience the CANDIDATE must acquire before being assigned to and perform the functions of this job, SATISFACTORILY under NORMAL supervision: One year - Less than 3 years

• SKILLS REQUIREMENT
• Skilled or specialized: proficiency is gained thru wide experience in a SPECIALIZED or TECHNICAL area
• Collaborates and liaises any Customer requests to concerned parties to ensure timely completion of Account Management Support
• Provides administrative support to Sales Team, Direct Clients, Agents and Brokers
• Collates data, prepares and submits weekly Monitoring Reports to Immediate Superior regarding concerns and other transactions endorsed by the Sales Team, Direct Clients, Agents and Brokers
• Responds to inquiries from Direct Clients, Agents and Brokers, collaborates with concerned Department on these inquiries