Call Center Specialist

DUTIES AND RESPONSIBILITIES:

• Review and evaluate request of Health Insurance Letters of Approval (LOA) submitted by hospitals, clinics, and policyholders.
• Approve or disapprove LOA requests based on policy coverage, eligibility, and company guidelines.
• Communicate decisions clearly and professionally to healthcare providers and policy holders.
• Handle inbound and outbound calls related to LOA requests, and policy inquiries.
• Provide guidance to policyholders on coverage, and required documentation.
• Maintain accurate records of LOA approvals/denials in the system for compliance and audit purposes.
• Ensure adherence to regulatory standards and company policies in all decisions.

REQUIREMENTS:

• Graduate of any Bachelor's degree in Health Sciences (e.g., Nursing, Medical Technology, Public Health, or related field).
• Strong understanding of medical terminology and healthcare processes.
• Minimum 1-2 years of experience in customer service, insurance, or healthcare administration is required.
• Prior health insurance or LOA processing experience is required.
• Excellent communication and decision-making skills.
• Ability to work under pressure and manage sensitive health-related information with confidentiality.
• Proficiency in MS Office and CRM systems.