Customer Service Specialist 1 | Calamba Office

Asalus Corporation (IntelliCare); Calamba; On-site; PHP 223,000 - 312,000; Full time

Job summary

Asalus Corporation (IntelliCare) is seeking a Customer Service Specialist 1 in Laguna to review and approve member requests for consultations and procedures under healthcare benefit plans. You will support members, answer inquiries, and ensure accurate processing of requests according to coverage, contributing to satisfaction and retention.

The role requires effective communication, empathy, multitasking, and willingness to work rotating shifts across morning, mid, and night schedules in a

Qualifications

• Graduate or undergraduate in an Allied Medical Course or Bachelor's Degree with at least six months of HMO experience.

Responsibilities

• Answer inquiries from members, providers, and facilities regarding benefits and procedures.
• Review and process requests for consultations, procedures, and services based on benefit plans.
• Verify member information, eligibility, coverage, and applicable limits before approvals.
• Ensure approvals follow company policies and authority levels.
• Maintain accurate records of transactions, inquiries, and approvals.
• Identify potential abuse or fraudulent claims and escalate to management.
• Deliver excellent customer service to promote member satisfaction and retention.

Skills

Effective communication

Empathy

Multitasking

Adaptability

Shift work

Active listening

Attention to detail

Typing 45 WPM

Education

Allied medical field Graduate or undergraduate; or Bachelor's degree with 6 months HMO experience

Tools

Office 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 escalate 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.