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
