Medical Benefits Pre-Approval Officer (Physician)

About the role

The Pre‑Approval Officer – Medical Benefits will join the Medical Benefits team in Clark, Pampanga. This position is responsible for reviewing and issuing pre‑approvals for medical services, ensuring coverage aligns with member eligibility, scheme terms, and utilisation history.

Key responsibilities

• Process pre‑approval requests from contracted medical providers according to SOPs and service level agreements.
• Assess eligibility and coverage using medical knowledge and departmental guidelines.
• Document approvals accurately to support claims administration and audit requirements.
• Prioritise cases based on medical urgency while adhering to policy references.
• Respond to call‑centre queries and online chats regarding coverage and claims.
• Complete system and written administration tasks in line with audit standards.

Required profile

• Filipino citizen or holder of a relevant residence status.
• Medical Degree from a recognised university and a current Philippine medical licence.
• At least 2 years post‑qualification experience, preferably in Emergency Room, General Practice or Family Medicine.
• Willingness to relocate to Clark, Pampanga.

Required skills

• Proficiency in Microsoft Excel.
• Proficiency in Microsoft Word.
• Proficiency in Microsoft PowerPoint.