Inpatient Care Officer

Role: INPATIENT CARE OFFICER Level: Supervisor Leadership Responsibility: Inpatient Blended Role Reporting Line: Assistant Manager - Provider Services, Customer Care Position Accountability Statement: The Inpatient Care Officer 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. 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. 1. 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. 2. Analyze escalations and address concerns related to inpatient services while assisting partner providers with questions about eligibility, coverage, and procedures. Offer first-hand solutions for captured complaints and escalate cases to internal departments (MRG, UEF, Sales) as necessary. 3. Offer, steer and deliver services to members of the Maxicare Primary Care Networks, recommended packages and low-cost providers while promoting Maxicare's exclusive benefits and helping members understand the available services. 4. Prepare and submit reports ensuring that data is accurate and comprehensive. These reports will help identify trends, and assess the effectiveness of current strategies to drive continuous improvement within the organization. 5. Can execute various campaigns and tasks as needed during manpower shortages, business continuity planning (BCP) events, or when service level agreements (SLA) for other teams or sub-units are critically low, ensuring operations remain smooth and responsive to immediate demands Desired Skills and Competencies: 1. Communication Skills: Strong verbal and written communication skills to explain coverage, handle inquiries, and liaise with various stakeholders effectively. 2. Customer Service Orientation: Focus on providing excellent service, including handling inquiries and complaints with professionalism and empathy. Understanding of Member’s Availment Guide (MAG) and familiarity with insurance coverage policies including customized benefits of corporate account. 3. Problem-Solving Abilities: Capacity to assess situations and escalate complex cases appropriately, while providing first-hand solutions when possible. 4. Organizational Skills:l 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. 5. Adaptability: Willingness to adjust to changing circumstances, especially during business continuity planning or manpower shortages. 6. Confidentiality and Ethics: Commitment to maintaining patient confidentiality and adhering to ethical standards in all operations. Professional Qualification: ● With a minimum of 2-3 years of Healthcare experience in Customer Care, preferably with experience on Voice, Non-Voice, and ER + IP campaigns/tasks (facilitate inquiry and LOA issuance). ○ No Derogatory record or administrative case and/or history of suspension for the past 2 years. ○ With Performance Appraisal rating not lower than 3.10 for the past two consecutive years. ○ Not involved with any valid Legal or IC complaints received by CMIT over the past year. ○ Overall CSAT Score for the past year is 90% and up ○ With a good record of productivity/scorecard and a willingness to handle various transactions over the past year