Provider Services Supervisor

<div><b>Role: INPATIENT CARE OFFICER</b></div><div><b>Level: Supervisor</b></div><div><b>Leadership Responsibility: Inpatient Blended Role</b></div><div><b>Reporting Line: Assistant Manager - Provider Services, Customer Care</b></div><div><b><br></b></div><div><b>Position Accountability Statement:</b></div><div>The Inpatient Care Officer plays a critical role in ensuring the smooth functioning of the overall Inpatient</div><div>Team and has a direct impact on the efficiency of the overall Inpatient Team's processes. This will improve</div><div>service delivery, uphold the quality and reliability of our services for Maxicare members, and support our</div><div>partner providers.</div><div><br></div><div><b>Broad Responsibility Highlights:</b></div><div>The following broad responsibility statements are representative of the basic expectations about the role or</div><div>function. Depending on business needs and exigencies, these responsibility statements may be modified.</div><div>Critical to any leadership function is the need to demonstrate flexibility and agility in adapting to the</div><div>changing requirements of the business.</div><div><br></div><div>1. Minimal to zero supervision to review, evaluate, and process Letters of Authorization (LOA)</div><div>following established procedures and professionally explain coverage and non-coverage details</div><div>during Member’s Availment Guide (MAG) discussion with admitted members.</div><div>2. Analyze escalations and address concerns related to inpatient services while assisting partner</div><div>providers with questions about eligibility, coverage, and procedures. Offer first-hand solutions for</div><div>captured complaints and escalate cases to internal departments (MRG, UEF, Sales) as necessary.</div><div>3. Offer, steer and deliver services to members of the Maxicare Primary Care Networks, recommended</div><div>packages and low-cost providers while promoting Maxicare's exclusive benefits and helping</div><div>members understand the available services.</div><div>4. Prepare and submit reports ensuring that data is accurate and comprehensive. These reports will</div><div>help identify trends, and assess the effectiveness of current strategies to drive continuous</div><div>improvement within the organization.</div><div>5. Can execute various campaigns and tasks as needed during manpower shortages, business</div><div>continuity planning (BCP) events, or when service level agreements (SLA) for other teams or</div><div>sub-units are critically low, ensuring operations remain smooth and responsive to immediate</div><div>demands</div><div><br></div><div><b>Desired Skills and Competencies:</b></div><div>1. Communication Skills: Strong verbal and written communication skills to explain coverage, handle</div><div>inquiries, and liaise with various stakeholders effectively.</div><div>2. Customer Service Orientation: Focus on providing excellent service, including handling inquiries</div><div>and complaints with professionalism and empathy. Understanding of Member’s Availment Guide</div><div>(MAG) and familiarity with insurance coverage policies including customized benefits of corporate</div><div>account.</div><div>3. Problem-Solving Abilities: Capacity to assess situations and escalate complex cases appropriately,</div><div>while providing first-hand solutions when possible.</div><div>4. Organizational Skills:l and Technical Proficiency: Proficiency in managing multiple tasks,</div><div>prioritizing effectively, and ensuring accurate documentation and filing of transactions. Experience</div><div>with CRM systems (like Salesforce) and telephony systems (like Genesys) for managing customer</div><div>interactions.</div><div>5. Adaptability: Willingness to adjust to changing circumstances, especially during business continuity</div><div>planning or manpower shortages.</div><div>6. Confidentiality and Ethics: Commitment to maintaining patient confidentiality and adhering to</div><div>ethical standards in all operations.</div><div><br></div><div><b>Professional Qualification:</b></div><div>● With a minimum of 2-3 years of Healthcare experience in Customer Care, preferably with experience</div><div>on Voice, Non-Voice, and ER + IP campaigns/tasks (facilitate inquiry and LOA issuance).</div><div>○ No Derogatory record or administrative case and/or history of suspension for the past 2 years.</div><div>○ With Performance Appraisal rating not lower than 3.10 for the past two consecutive years.</div><div>○ Not involved with any valid Legal or IC complaints received by CMIT over the past year.</div><div>○ Overall CSAT Score for the past year is 90% and up</div><div>○ With a good record of productivity/scorecard and a willingness to handle various transactions</div><div>over the past year</div>