Job Description
- Assisted members, patients, and healthcare providers by responding to inquiries via phone, email, and chat while delivering exceptional customer service.
- Verified member eligibility, benefits, and coverage details in accordance with healthcare policies and procedures.
- Resolved concerns related to claims, billing, authorizations, provider networks, and plan benefits accurately and efficiently.
- Documented customer interactions, case updates, and resolutions in CRM and healthcare systems while maintaining data accuracy.
- Escalated complex issues to appropriate departments and ensured timely follow-up until resolution.
- Educated members on healthcare plans, available services, and self-service resources to improve customer experience.
- Maintained compliance with HIPAA and company policies by safeguarding confidential patient and member information.
- Met or exceeded key performance indicators (KPIs), including quality assurance, customer satisfaction (CSAT), average handle time (AHT), and first-call resolution (FCR).
- Collaborated with cross-functional teams to ensure seamless issue resolution and continuous process improvement.
- Demonstrated professionalism, empathy, and active listening skills when handling sensitive healthcare-related concerns.
Responsibilities
- Responded to customer inquiries regarding healthcare plans, benefits, claims, billing, and eligibility via phone, email, or chat.
- Verified member information and updated customer records accurately in company systems.
- Resolved customer concerns while ensuring a high level of professionalism, empathy, and customer satisfaction.
- Explained healthcare policies, coverage, and available services in a clear and understandable manner.
- Assisted members with claims status, prior authorizations, referrals, and provider network information.
- Documented all customer interactions, inquiries, and resolutions in accordance with company guidelines.
- Escalated complex or unresolved issues to the appropriate department for timely resolution.
- Protected confidential patient and member information by complying with HIPAA and company privacy policies.
- Met or exceeded key performance metrics, including quality, productivity, customer satisfaction, and first-call resolution.
- Collaborated with internal teams to ensure accurate and efficient service delivery.
Highschool diploma or equivalent with at least 6 months of BPO experience (International Account) (Undergraduates, can be processed but more thorough with screening, no plans in continuing further education)
College Graduate with or without work experience. (Four-year graduate with or without experience (must have excellent comms)
Minimum Salary is 19200
Maximum Salary is 20400
HMO Plus 2 Dependents,
Life Insurance
,Night Differential Pay
13th Month Pay,
Paid Leaves,
Government Mandated Benefits
