Healthcare Coordinator ? Turnos Rotativos

Con oficinas en Panama, Ecuador, y Colombia, ¡VUMI® está buscando el mejor TALENTO!

VUMI® es una compañía internacional de seguros de salud que ofrece productos exclusivos de seguros médicos principales y servicios médicos VIP a clientes privados y corporativos en todo el mundo. Los productos VUMI® están diseñados para brindarle beneficios únicos y una amplia cobertura global. Lo más importante es que VUMI® le brinda tranquilidad, estará cubierto en todo momento, en cualquier parte del mundo. VUMI® tiene oficinas operativas en todo el mundo y emplea a más de 500 profesionales multinacionales. La compañía es de propiedad privada y parte de un grupo internacional de atención médica con 35 años de experiencia en la industria.

Con oficinas en Panama, Ecuador, y Colombia, ¡VUMI® está buscando el mejor TALENTO!

Resumen del Cargo:

Analyze pre-authorization requests, monitor incoming emails, and distribute upcoming cases among peers. Handle phone calls from providers, agents, and members, opening cases in the system for further processing and following up throughout the shift. Create and submit letters of guarantee to providers and agents. Track the progress of cases assigned to him/her, as well as those opened by other coordinators during or prior to his/her shift. Reach out to providers via phone or email to inquire about case details, request additional information, and verify the status of cases or patients.


Requisitos:
Responsibilties

- Manages notification, preauthorization and eligibility requests via email from Member, Producers, and Providers for assigned region;handles within given deadline and service objectives.
- Reviews medical services against policy to determine coverage and exclusions, reads physician information and decides compensability;may request additional information such as medical records to assist in decision making.
- Coordinates the negotiation of rates with physicians or third parties outside the network for cases over usual and customary rates to ensure cost contention.
- Create and send letters of authorization and explanations of benefit depending on the outcome of case evaluations to Agents/Clients and Providers.
- Create and send denial letters to Providers depending on outcome of case evaluations and coordinate with Medical Team to send denial letters to Agents/Clients.
- Coordinates air transfer logistics and authorizations.
- Enters notes for every conversation, email and decision in the system so that it is available company wide.
- Performs outbound follow-up calls to provider to verify receipt GOP
- Performs outbound follow-up calls to client to verify services were received or if there is anything else needed.
- Answer inbound calls from Providers, Agents/Clients, as needed, for the coordination of a medical case.
- Participates in on-call shifts during after hours, weekends and holidays, and coordinates emergency cases received during those shifts.
- May perform other functions as assigned by supervisors.

Skills

- Bilingual, high level of proficiency in English and Spanish. Portuguese is an additional requirement.
- Experience in the life health insurance industry.
- Experience handling telephone calls and customer service. 
- Excellent oral and written communication skills, assertive and articulate.
- Ability to work in a team and collaborate.
- Strong interpersonal skills and attention to detail.
- Proficient with Microsoft Office programs, such as Word, Excel, PowerPoint, and others.

Qualifications and Experience

- Holds a University Degree or has the equivalent education and or experience combination
- Solid 1-3 years? experience in Health Insurance Claims Service/Precertification area, preferred.
- Keen attention to detail and willing to tackle repetitive tasks
- Self-starter with positive working attitude, good team player and ability to work occasional overtime, especially at month end
- Responsible and mature individual
- Strong English (speech, reading and writing) is required. (at least Proficiency C1)
- Portuguese knowledge is required. (at least Proficiency C1)

How to Apply

Interested parties are invited to send their cover letter and resume with salary expectations. Candidates who are not invited for interviews within 4 weeks may consider their application unsuccessful and should consider their application filed for future positions.


Beneficios - Corporate health and hospitalization medical insurance. (after completing 3 months of probation period)
- Pluxee Food voucher $50.00 monthly. (after completing 3 months of probation period)
- WFH (after completing 3 months of probation period)
- Christmas bonus.
- Parking
- Integration and Social Responsibility Activities ? Environment and other benefits.
- Birthday Leave