Helpdesk Specialist

Job Title: Helpdesk Specialist

Department: Customer Care - Provider Services

Division: Operations

Reports to (Position of Immediate Superior): Helpdesk Supervisor

I. Primary Job Responsibility

Accountable for the accurate implementation of members’ healthcare benefit policies at the assigned

Helpdesks focusing on utilization management and the delivery of superior customer service s

Job Description

• Duties and Responsibilities done at PERIODIC or REGULAR Intervals
• Issues Letter of Authority after assessment of coverage, professionally explains non-coverage rationale to members
• Responds inquiries and complaints, resolves customers’ feedback and issues raised regarding handling time and waiting time
• Encodes manual LOAs within the issuing day through automated data system of Maxicare
• Secures overriding approval from the Helpdesk Supervisor for LOAs beyond Helpdesks CCS authority limits
• Provides support the Immediate Superior on Follow-up On-site Orientation and training especially to the new CCRS, as well as in preparing and submitting reports on census, decking of doctors, POS queue reports and manual LOA reports
• Ensures operating costs reduction by property implementing use of office facilities including power, internet and phones at Helpdesk
• Duties and Responsibilities done at IRREGULAR or INTERMITTENT Intervals
• Ensures understanding of KRA targets such as timely handling of availing services, serving time, waiting time, and other metrics to efficiently achieve targets
• Forwards LOA to Cost Centers, Departments or Doctor’s clinics
• Trains new CCRs
• Updates the system files on doctors’ schedules and rates of procedures and tests, informs provider relations team of the changes or updates
• Endorses In-Patient cases to the Roving Department
• Assists or accompanies VIP Members to the clinic, laboratories, radiology clinics, and other facilities
• Refers and redirects members to inexpensive clinics or hospitals for availing same services
• STANDARD RESPONSIBILITY STATEMENTS

✓ Strives to embody, commits to support and deliver the quality policy, objectives and initiatives of the organization;

✓ Communicates, engages, directs and supports people to contribute to the QMS effectiveness;

✓ Demonstrates commitment to customers by ensuring applicable statutory and regulatory requirements are determined, understood and consistently met;

✓ Abides by the QMS policies and procedures for the effective management and control of its processes; and

✓ Promotes and utilizes the Process Approach and Risk-based Thinking at work.

✓ Performs other RELATED functions that may be assigned BY THE IMMEDIATE SUPERIOR

✓ Onsite support, strategically other sites or accounts as needed by the Operations team.

✓ Promote and offer Primary Care Network Directions.

II. JOB SPECIFICATIONS

• SKILLS
• EDUCATIONAL REQUIREMENT

MINIMUM educational level and background required by this POSITION: Medical Allied Courses

College Graduate of 4, 5 year-course, preferably: Medical Allied Courses

• EXPERIENCE AND TRAINING

PERIOD OF TIME OR LENGTH of related experience the CANDIDATE must acquire before being

assigned to and perform the functions of this job, SATISFACTORILY under NORMAL supervision:

No Experience - Less than 1 year

• SKILLS REQUIREMENT – TECHNICAL (For Tech and Business Support, Supervisory and Professional)

Skilled or specialized: proficiency is gained thru wide experience in a SPECIALIZED or TECHNICAL area

• RESPONSIBILITY

ACCOUNTABILITY – ASSETS, CASH, EQUIPMENT

Value or worth of company assets (cash, checks, financial instruments, investments, tools, materials, machinery, equipment, and supplies) this POSITION is accountable for: Small below P500, 000

SPECIFY ASSETS, CASH AND EQUIPMENT DIRECTLY ACCOUNTED FOR: Mobile Phone

• ACCOUNTABILITY – RECORDS AND DOCUMENTS

Level of CONFIDENTIALITY AND IMPORTANCE of the information, records, reports, and documents prepared, maintained, has access to, and handled by this POSITION Routinely, Low - Contents are of general nature; knowledge by others is NOT INIMICAL; disclosure may not have apparent effect on the company

RECORDS AND DOCUMENTS DIRECTLY ACCOUNTED FOR: None

• NEED FOR SUPERVISION

EXTENT of work supervised or managed by the Immediate Superior, whether the job is limited or diversified; quantify range of activities, VARIETY of tasks to be carried out, and the DIVERSITY of the problem to be solved Follows established procedures generally; refer only unusual cases to superior

• PEOPLE MANAGEMENT

Number of subordinates this POSITION DIRECTLY supervise None

• CONTACTS – INTERNAL AND EXTERNAL

EXTENT the work required in making personal contacts inside and outside of the organization, level of importance of contacts; FREQUENCY they are made; LEVEL OR DEGREE they involve exchanging information, dealing with people, exerting influence, persuading them to take action, etc. Localized, Routine