Customer Service Specialist 1 - Pampanga

Asalus Corporation (IntelliCare); Mabalacat; On-site; PHP 179,000 - 290,000; Full time

Job summary

Asalus Corporation (IntelliCare) is seeking a Customer Service Specialist 1 to review and approve member requests for consultations and procedures based on healthcare benefits. You will provide member support, answer inquiries, and ensure accurate processing in line with benefit plan coverage, contributing to customer satisfaction and client retention.

The role requires strong communication, attention to detail, and the ability to work in a rotating shift schedule onsite at Clark Freeport Zone,

Qualifications

• Graduate or undergraduate in Allied Medical Course or with at least six months of experience in the HMO industry.
• Experience in HMO, healthcare, or medical facility is an advantage.
• Excellent verbal and written communication.
• Willing to work rotating shifts.
• Computer literate and proficient in basic office applications.
• Typing speed of at least 45 WPM.
• Detail-oriented with accuracy.
• Ability to review and process healthcare requests per policy.

Responsibilities

• Answer inquiries from members, healthcare providers, and facilities about benefits, coverage, and procedures.
• Process requests for consultations, procedures, and services based on benefit plans.
• Verify member information, eligibility, coverage, providers, and limits before approvals.
• Ensure approvals follow policies and levels of authority.
• Maintain accurate records of transactions, inquiries, and approvals.
• Identify potential abuse or fraud and report to proper heads for investigation.
• Deliver excellent customer service to promote satisfaction and retention.

Skills

Communication skills

Empathy

Multitasking

Willingness to learn

Shift flexibility

Critical thinking

Active listening

Computer literate

Typing 45 WPM

Attention to detail

Healthcare knowledge

Education

Allied medical background

Healthcare industry experience

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 elevate 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: 7F Clark City Front Tower 2, Manuel A. Roxas Highway, Clark Freeport Zone, Pampanga 2009