Dr. Amando L. Garcia Medical Center, Inc jobs

Your duties include, but are not limited to the following:

• Receive and handle inbound member calls professionally, applying active listening, empathy, and AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You) communication standards in every interaction.
• Conduct outbound follow-up calls to members as assigned, including callback fulfillment for missed calls and resolution follow-throughs.
• Manage member inquiries received through email and messaging channels (e.g., Viber) in compliance with FIFO processing protocols and departmental response-time standards.
• Provide accurate, verified information on MPI member benefits, coverage, accredited providers, and claims status; refrain from providing estimates or information not confirmed by official sources or case owners.
• Escalate calls that exceed standard handling scope — including irate members, clinical edge cases, and complex benefit disputes — to the designated floor lead or Member Care Specialist without delay.
• Create Letters of Authorization (LOAs) for member consultations, procedures, confinements following established MPI authorization protocols and within approved timelines.
• Process Annual Physical Examination (APE) and Dental benefit availments, coordinating with accredited providers as needed.
• Support discharge coordination workflows as assigned, providing members and healthcare facilities with accurate LOA, coverage, and processing information.
• Escalate ER Guard emergency pre-authorization concerns to the designated ER Guard-assigned team member or Member Care Specialist immediately.
• Receive and log member inquiries related to reimbursement claims, hospitalization benefits, and claim processing status.
• Coordinate with the Claims Department to relay accurate, confirmed status updates to members, referencing the inter-departmental case tracker for verified information.
• Provide members with a reference or ticket number for their inquiry and document all communication accurately in the system.
• Escalate unresolved, aging, or irate claims concerns to the floor lead or Specialist per the defined escalation timeline.
• Log in to the PAB telephony system and confirm queue readiness within the required timeframe at the start of each shift and immediately upon returning from approved break periods.
• Maintain accurate after-call work documentation within the prescribed after-call time window.
• Adhere to the daily workforce assignment plan, executing the assigned workstream - inbound calls, outbound calls, LOA creation, or email/Viber-as directed by the floor lead or supervisor.
• Comply fully with timekeeping requirements: clock in and out for the meal break via the HRIS biometric system, adhere to the two-break limit per shift, and never proceed to a break immediately after clocking in.
• Observe all workplace conduct standards including the personal device restriction and work-only internet policy while on the operations floor.
• Participate actively in team huddles, training sessions, competency reassessments, and coaching conversations.
• Flag recurring member concerns, system issues, or process gaps to the floor lead to support continuous improvement.
• Support team capacity during high-volume periods as directed, including temporary redeployment to inbound calls from other workstreams.

Benefits:

• Company Christmas gift
• Company events
• Health insurance
• Opportunities for promotion

Work Location: In person