Customer Service Specialist 1

Asalus Corporation (IntelliCare); Makati; On-site; PHP 260,000 - 380,000; Full time

Job summary

Asalus Corporation (IntelliCare) in Makati seeks a Customer Service Specialist 1 to review and approve member requests for consultations and procedures based on healthcare benefits, focusing on outpatient and dental services. You will assist members, answer inquiries, and ensure accurate processing per benefit plans.

You will maintain records, handle shifting schedules, and uphold service standards to support client satisfaction and retention.

Qualifications

• Educational requirement: Graduate or undergraduate of any Allied Medical Course; or Graduate or undergraduate of any bachelor's degree with at least six (6) months of experience in the HMO industry.
• Relevant work experience: Experience in an HMO setting, healthcare industry, or medical facility is an advantage.
• Personal characteristics: Effective communication skills in both oral and written formats; patient and empathetic in dealing with members, providers, and colleagues; ability to multitask and work efficiently under pressure; willingness to learn and adapt; willingness to work on rotating shifts.
• Required competencies: Strong critical thinking and problem-solving; good communication and active listening; computer literate and proficient in basic office apps; typing speed of at least 45 WPM; strong attention to detail; ability to review and process healthcare requests per benefit provisions.

Responsibilities

• Answer inquiries from members, healthcare providers, and facilities regarding healthcare benefits, coverage, and availment procedures.
• Receive, review, and process requests for consultations, procedures, and other healthcare services based on members' benefit plans.
• Verify member information, eligibility, benefit coverage, doctors and facilities, and applicable limits before issuing approvals.
• Ensure all approvals are processed per company policies, benefit guidelines, and levels of authority.
• Maintain accurate records of transactions, approvals, inquiries, and related activities.
• Identify potential abuse or fraudulent claims and escalate accordingly for investigation.
• Deliver excellent customer service to promote member satisfaction and client retention.

Skills

Communication skills

Empathy

Multitasking

Attention to detail

Data entry

Typing 45 WPM

Education

Allied Medical Course (any degree)

Tools

MS Office

Healthcare software

Job description

JOB PURPOSE

The Customer Service Specialist 1 reviews and approves members' requests for consultations and procedures based on their healthcare benefits, particularly for Outpatient and Dental services. The role provides member support, answers inquiries, and ensures requests are processed accurately in accordance with benefit plan coverage, contributing to customer satisfaction and client retention.

DUTIES & RESPONSIBILITIES

• Answer inquiries from members, healthcare providers, and accredited medical facilities regarding healthcare benefits, coverage, and availment procedures.

• Receive, review, and process requests for consultations, procedures, and other healthcare services based on members' benefit plans.

• Verify member information, eligibility, benefit coverage, accredited doctors and facilities, and applicable limits before issuing approvals.

• Ensure that all approvals are processed in accordance with company policies, benefit guidelines, and established levels of authority.

• Maintain accurate and complete records of transactions, approvals, inquiries, and related activities.

• Identify potential abuse, misuse, or fraudulent claims and immediately escalated and report such cases to the appropriate department heads for investigation.

• Deliver excellent customer service to promote member satisfaction and contribute to client retention.

JOB QUALIFICATIONS

• Educational Requirement
  - Graduate or undergraduate of any Allied Medical Course; or Graduate or undergraduate of any bachelor's degree with at least six (6) months of experience in the HMO industry.

• Relevant Work Experience
  - Experience in an HMO setting, healthcare industry, or medical facility is an advantage.

• Personal Characteristics and Behaviors
  - Effective communication skills in both oral and written formats.
  - Patient and empathetic in dealing with members, providers, and colleagues.
  - Ability to multitask and work efficiently under pressure.
  - Willingness to learn and adapt to changes in processes and procedures.
  - Willing to work on shifting schedules (morning, mid, and night shifts).

• Required Competencies
  - Strong critical thinking and problem-solving skills to analyze and resolve customer service concerns while exercising sound judgment and initiative.
  - Good communication and active listening skills.
  - Computer literate and proficient in basic office applications.
  - Typing speed of at least 45 words per minute (WPM).
  - Strong attention to detail and accuracy.
  - Ability to review and process healthcare requests in accordance with benefit plan provisions, company guidelines, and service standards.

NOTE:

Schedule & Work Setup: Rotational Shifting Schedule | Full-Time Onsite

Work Location: Ground Floor, Feliza Building, 108 V.A. Rufino St., Legaspi Village, Makati City