Empathy-Driven Healthcare Member Support Specialist

Metacom Careers; Muntinlupa; On-site; PHP 240,000 - 360,000; Full time

Job summary

Metacom Careers is seeking a Healthcare Customer Service Representative to provide high-quality support to members, patients, healthcare providers, and authorized representatives by answering inquiries about health insurance benefits, eligibility, claims, billing, and related services.

The role focuses on resolving customer concerns, processing account requests, maintaining accurate documentation, and delivering empathetic, patient-centered service while ensuring HIPAA compliance and meeting

Qualifications

• High school diploma or equivalent required; an associate's or bachelor's degree is an advantage.
• No prior experience required; customer service, healthcare, or call center experience is a plus but not mandatory.
• Strong verbal and written communication skills.
• Ability to maintain confidentiality and comply with HIPAA and company standards.

Responsibilities

• Respond to customer inquiries via phone, email, chat, or other channels.
• Assist members with questions about eligibility, coverage, deductibles, copayments, coinsurance, out-of-pocket costs, and plan benefits.
• Process enrollment and account updates, address changes, ID card replacements, provider changes, and other member services.
• Investigate and resolve claims, billing, payment, and reimbursement inquiries with accurate information and timely follow-up.
• Verify member information and protect confidential health information per HIPAA and company policies.
• Educate members on healthcare plans, provider networks, referrals, and available resources.
• Coordinate with healthcare providers, pharmacies, and internal departments to resolve concerns efficiently.
• Document customer interactions and case resolutions in CRM systems and healthcare applications.
• Escalate complex concerns to the appropriate department when necessary.
• Deliver empathetic, patient-centered service while maintaining professionalism and confidentiality.

Skills

Customer Service Excellence

Effective Communication

Active Listening

Problem Solving

Empathy and Compassion

Attention to Detail

Computer Proficiency

Data Entry Accuracy

Time Management

Multitasking

Adaptability

Teamwork

Professionalism

Willingness to Learn

Education

High school diploma or equivalent

Associate's or Bachelor's degree advantageous

Job description

Metacom Careers is seeking a Healthcare Customer Service Representative to provide high-quality support to members, patients, healthcare providers, and authorized representatives by answering inquiries about health insurance benefits, eligibility, claims, billing, and related services.

The role focuses on resolving customer concerns, processing account requests, maintaining accurate documentation, and delivering empathetic, patient-centered service while ensuring HIPAA compliance and meeting