Field Liaison Officer

MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard.

The MediCard Liaison Officer (LO) serves as a Care Partner and Member Advocate, ensuring that members receive timely, medically appropriate, cost-effective, and seamless services within the healthcare ecosystem.

Job Description

DUTIES & RESPONSIBILITIES

1. Healthcare Navigation

• Serve as the primary point of contact for members within assigned healthcare facilities.
• Guide members in accessing appropriate healthcare services and providers.
• Assist members in understanding healthcare benefits, limitations, and available options.
• Provide support throughout admission, confinement, treatment, and discharge processes.
• Facilitate referrals and coordination of care as needed.
• Assist members in navigating complex healthcare situations.

Success Indicators

• High member satisfaction ratings
• Improved healthcare navigation experience
• Reduced member confusion and escalations

1. Benefit Implementation and Management

• Verify member eligibility and benefit coverage.
• Facilitate timely processing of approvals and authorizations.
• Explain the coverage, limitations and exclusions, as well as requirements.
• Ensure services rendered are within approved benefits and coverage guidelines.
• Support efficient claims and documentation processes.
• Compliance with authorization turnaround times
• Reduced benefit-related complaints
• Accurate benefit application

1. Medical Appropriateness and Care Coordination

• Facilitate implementation of MediCard utilization management policies.
• Coordinate with healthcare providers regarding covered healthcare services.
• Support medically necessary and evidence-based healthcare practices.
• Promote treatment in the most appropriate level of care.
• Escalate complex medical necessity concerns to designated clinical teams.
• Appropriate utilization of healthcare resources
• Reduced unnecessary admissions and procedures
• Positive provider collaboration

1. Member Experience Excellence

• Deliver compassionate and professional member support.
• Practice active listening and empathy during member interactions.
• Manage concerns and complaints promptly.
• Conduct service recovery activities when necessary.
• Ensure every member interaction reflects MediCard's brand promise.
• Member Satisfaction Score targets achieved
• Increased Net Promoter Score (NPS)
• Timely complaint resolution

1. Provider Relationship Management

• Develop positive working relationships with hospital personnel and physicians.
• Promote collaborative problem-solving.
• Support provider awareness of MediCard processes.
• Participate in provider engagement activities.
• Gather provider feedback for service improvement.
• Positive provider satisfaction ratings
• Reduced operational disputes
• Improved provider collaboration

1. Operational and Compliance Excellence

• Maintain accurate documentation and records.
• Comply with Data Privacy Act requirements and company policies.
• Adhere to established service level agreements (SLAs).
• Ensure timely reporting and escalation of critical issues.
• Participate in quality improvement initiatives.
• Audit compliance
• Zero major privacy incidents
• SLA achievement

1. Brand Ambassador Responsibilities

• Promote MediCard’s brand promise.
• Educate members regarding Medicard’s services.
• Participate in member education campaigns.
• Support brand awareness initiatives within healthcare facilities.
• Demonstrate professionalism and service excellence consistently.
• Increased awareness of LO role
• Positive member and provider perception
• High brand compliance scores

MINIMUM QUALIFICATIONS

• Education Required:

+ Bachelor's Degree in:

• Nursing
• Medical Technology
• Physical Therapy
• Pharmacy
• Healthcare Administration
• Allied Health Sciences
• Other healthcare-related courses
• Preferred:

+ Registered Nurse (RN) + Other licensed healthcare professional

• Experience Required:

+ Minimum 2–3 years experience in:

• HMO Operations
• Hospital Operations
• Utilization Management
• Case Management
• Patient Relations
• Healthcare Customer Service
• Preferred:

+ Experience within HMO or managed healthcare environment + Experience in member engagement and care coordination + Experience working with physicians and hospital administrators