HMO Benefits Associate

Full-time PRB

Key Responsibilities

• Administer end-to-end HMO enrollment, including new hires, dependents, status updates, terminations, and annual renewals.
• Verify employee and dependent eligibility based on company policies and HMO provider requirements.
• Coordinate with HMO providers to process enrollments, amendments, cancellations, and issuance of HMO membership cards.
• Process and monitor Letters of Authorization (LOAs), guarantee letters, reimbursements, and other HMO-related requests.
• Liaise with HMO account managers, hospitals, clinics, and accredited healthcare providers to facilitate healthcare services and resolve benefit concerns.
• Assist employees with inquiries regarding HMO coverage, benefits, accreditation, claims, reimbursements, and healthcare procedures.
• Investigate and resolve HMO enrollment discrepancies, denied claims, billing issues, and other healthcare benefit concerns.
• Prepare, vali...