In-house Patient Care Officer
Core
Acts as the face of MediCard within healthcare facilities, guiding members through their healthcare journey, facilitating benefit utilization, and coordinating with healthcare providers to ensure quality outcomes and compliance.
Role type
In-house Patient Care Officer (Healthcare Navigator & Utilization Steward)
Builds
Member access to appropriate care at the right time and cost via virtual channels
Domain
Health Insurance / Managed Care / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Member eligibility verification, benefit coverage explanation, authorization processing, care coordination, utilization management, stakeholder communication, virtual channel support, case management, complaint resolution
Preferred skills
Active listening, empathy, service recovery, proactive communication, collaborative problem-solving
Technologies
Phone, email, chat, video consultation, digital platforms
Responsibilities
Verify member eligibility and benefit coverage; Facilitate timely processing of approvals and authorizations; Guide members through authorization and healthcare access processes; Coordinate with providers, hospitals, and internal clinical teams; Manage customer concerns, complaints, and escalations; Assist in discharge planning and continuity of care.
Seniority
Individual Contributor, operational level
