Clinical Customer Service Representative

Metacom Careers; Muntinlupa; On-site; PHP 300,000 - 480,000; Full time

Benefits offered by this job

Performance bonus

Incentives

HMO

Job training

Professional development

Job summary

Metacom Careers is seeking a Healthcare Customer Service Representative to support healthcare members via inbound calls, addressing benefits, eligibility, claims and pre-authorization. The ideal candidate will have experience with international accounts, strong communication, and problem-solving skills within a hybrid work setup.

Responsibilities include handling inquiries, documenting call details, and maintaining confidentiality while meeting service quality standards.

Qualifications

• College Graduate or Associate Graduate, any course.
• BS Nursing graduates are excluded from this position.
• At least 2 years of call center experience handling international accounts.
• Experience catering to healthcare members, particularly with: Prior Authorization / Pre-Auth; Benefits and Eligibility; Claims.
• Excellent listening and comprehension skills.
• Strong analytical and problem-solving abilities.
• Good interpersonal and customer service skills.
• Comfortable handling healthcare-related concerns through voice interactions.
• Willing to work under a hybrid setup and follow the required work schedule.

Responsibilities

• Handle inbound calls from healthcare members and provide accurate assistance.
• Assist members with benefits and eligibility inquiries.
• Address claims-related concerns and provide appropriate information.
• Assist with prior authorization (pre-auth) inquiries and processes.
• Clearly explain healthcare-related information and procedures.
• Verify and document member information and call details accurately.
• Use active listening, analytical thinking, and problem-solving skills to resolve concerns.
• Escalate complex issues to the appropriate team when necessary.
• Maintain confidentiality when handling member information.
• Meet established customer service, quality, productivity, and attendance standards.

Skills

Call center experience

Communication skills

Problem solving

Education

College Graduate or Associate Graduate

Job description

Clinical Customer Service Representative

Hybrid - Muntinlupa 1-3 Yrs Exp Bachelor Full-time

Employee Recognition and Rewards

Performance Bonus, Incentives

Insurance Health & Wellness

HMO

Professional Development

Job Training, Professional Development

We are looking for a Healthcare Customer Service Representative to provide professional support to healthcare members through inbound calls. The role involves assisting members with concerns related to benefits and eligibility, claims, and prior authorization (pre-auth) while ensuring accurate and efficient service.

The ideal candidate has experience handling international healthcare accounts, strong communication skills, and the ability to effectively understand and resolve member concerns.

Key Responsibilities

• Handle inbound calls from healthcare members and provide accurate assistance.
• Assist members with benefits and eligibility inquiries.
• Address claims-related concerns and provide appropriate information.
• Assist with prior authorization (pre-auth) inquiries and processes.
• Clearly explain healthcare-related information and procedures.
• Verify and document member information and call details accurately.
• Use active listening, analytical thinking, and problem-solving skills to resolve concerns.
• Escalate complex issues to the appropriate team when necessary.
• Maintain confidentiality when handling member information.
• Meet established customer service, quality, productivity, and attendance standards.

Qualifications

• College Graduate or Associate Graduate, any course.
• BS Nursing graduates are excluded from this position.
• At least 2 years of call center experience handling international accounts.
• Experience catering to healthcare members, particularly with:
• Prior Authorization / Pre-Auth
• Benefits and Eligibility
• Claims
• Excellent listening and comprehension skills.
• Strong analytical and problem-solving abilities.
• Good interpersonal and customer service skills.
• Comfortable handling healthcare-related concerns through voice interactions.
• Willing to work under a hybrid setup and follow the required work schedule.

English Language Customer Service Problem Solving Technical Skills Organizational Skills