Job Description

We are looking for a Healthcare Member Services Representative to provide professional and compassionate customer support to healthcare members. The role involves assisting customers with healthcare-related inquiries, explaining benefits and coverage, resolving concerns, and ensuring a positive member experience.

Key Responsibilities

Handle inbound calls and customer inquiries regarding healthcare services, benefits, eligibility, claims, and coverage.
Provide accurate and easy-to-understand information while maintaining professionalism and empathy.
Assist members with account-related concerns, provider information, billing questions, and service requests.
Research and resolve customer concerns efficiently while following established procedures and healthcare guidelines.
Document customer interactions, inquiries, and resolutions accurately in the system.
Coordinate with internal teams and healthcare providers when necessary to resolve complex concerns.
Protect confidential member information and follow applicable privacy and security policies.
Meet established quality, productivity, attendance, and customer satisfaction standards.
Maintain a professional and courteous approach when handling difficult or sensitive customer situations.
Stay updated on healthcare plans, policies, procedures, and available services.

Qualifications

High school diploma, senior high school diploma, or equivalent.
Previous customer service, call center, BPO, healthcare, or medical account experience is an advantage.
Excellent verbal and written communication skills.
Strong listening, problem-solving, and multitasking abilities.
Comfortable using computers and navigating multiple systems.
Willing to work on shifting schedules, weekends, and holidays when required.
Able to handle sensitive customer information with confidentiality and professionalism.

HMO,

Night Differential Pay,

Rice Allowance,

Paid Leaves,

Government Mandated Benefits,

13th Month Pay