Customer Service Representative (Healthcare Account) - SBA

John Clements Consultants, Inc.; Taguig; On-site; PHP 223,000 - 312,000; Full time

Job summary

John Clements Consultants, Inc. is seeking a Healthcare Customer Service Representative to handle inbound and outbound calls, providing information on health plan benefits, coverage, and claims.

The role requires coordination with the Claims Department and healthcare providers to resolve concerns. Candidates should have at least 1 year in healthcare or health insurance customer service, familiarity with Medicare plans, and a willingness to work the night shift onsite at BGC, Taguig.

Qualifications

• High school diploma is required.
• At least 1 year of healthcare-related claims or customer service experience.
• Experience with Medicare or Medicare Advantage is preferred.
• Healthcare BPO/call center experience is advantageous.

Responsibilities

• Handle inbound customer service calls and assist with healthcare-related inquiries.
• Provide accurate information regarding health plan benefits, coverage, and claims.
• Research customer claims using primary payer systems.
• Coordinate with the Claims Department and healthcare providers to resolve concerns.
• Document customer interactions accurately in ticketing/tracking systems.
• Escalate complex claims or customer concerns following established processes.
• Maintain complete and accurate records of all customer interactions and transactions.

Skills

Verbal communication

Written communication

Attention to detail

Problem-solving

Customer service

Microsoft Word

Microsoft Excel

Night shift readiness

On-site work

Education

High school diploma

Tools

Microsoft Word

Microsoft Excel

Job description

About the role

Handle inbound and outbound customer service calls to assist with healthcare-related inquiries. Provide accurate information regarding health plan benefits, coverage, and claims. Research customer claims using primary payer systems and coordinate with the Claims Department and healthcare providers to resolve concerns.

Key responsibilities

• Handle inbound customer service calls and assist with healthcare-related inquiries
• Manage outbound call requests and follow up on customer concerns
• Provide accurate information regarding health plan benefits, coverage, and claims
• Research customer claims using primary payer systems
• Document customer interactions accurately in ticketing and tracking systems
• Coordinate with the Claims Department and healthcare providers to resolve concerns
• Assist customers with questions regarding plan benefits, eligibility, and coverage
• Escalate complex claims or customer concerns following established processes
• Maintain complete and accurate records of all customer interactions and transactions

About you

• High school diploma required
• At least 1 year of experience in healthcare, medical claims, health insurance, or healthcare customer service
• Healthcare claims or health insurance experience is highly preferred
• Healthcare BPO/call center experience
• Knowledge of Medicare or Medicare Advantage plans
• Familiarity with healthcare benefits, insurance coverage, and claims processes
• Excellent verbal and written communication skills
• Strong attention to detail, problem-solving, and customer service skills
• Basic knowledge of Microsoft Office, particularly Word and Excel
• Willing to work night shift and onsite in BGC, Taguig

Location: BGC, Taguig
Work Setup: Fully onsite
Schedule: Night shift
Employment Type: Fixed-term contract, 6 months