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 compliance with policies and medical necessity standards.
Role type
In-house Patient Care Officer (Healthcare Navigator & Utilization Steward)
Builds
Member healthcare access pathways, benefit utilization, and care coordination outcomes
Domain
Health Insurance / Managed Care / Utilization Management
Deliverable
dashboards & analysis
Required skills
Member eligibility verification, benefit coverage explanation, authorization processing, care coordination, utilization management, stakeholder communication, documentation management, service recovery
Preferred skills
Active listening, empathy, proactive communication, conflict resolution
Technologies
Virtual channels (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; Promote evidence-based and medically necessary healthcare utilization; Manage customer concerns, complaints, and escalations promptly.
Seniority
Individual Contributor, operational level