Healthcare Admin & Member Services Specialist

Proserve Business Consultancy Service; Cebu City; On-site; PHP 180,000 - 360,000; Full time

Job summary

Proserve Business Consultancy Service is seeking a dedicated Administrative Services Specialist to support TPAs, health plans, and self-funded employers. The role focuses on delivering high-quality administrative and healthcare operations services while ensuring compliance with regulations and client requirements.

Responsibilities include member/provider support, enrollment processing, and coordinating authorization activities, with an emphasis on accuracy, efficiency, and quality of service in

Qualifications

• High School Diploma or equivalent required.
• Associate's or Bachelor's degree preferred.
• 2+ years of healthcare administration, customer service, health insurance, or revenue cycle experience.
• TPA, payer or provider experience.
• Contact center experience preferred.

Responsibilities

• Provide exceptional customer service to members, providers, employer groups, and plans.
• Assist members with benefits, eligibility, enrollment, claims status, ID cards.
• Support providers with payment inquiries, demographic updates, credentialing, and issue resolution.
• Process eligibility, enrollment, terminations, and coverage changes accurately.
• Support claims administration activities (non-adjudication).
• Coordinate prior authorization and pre-certification support.
• Document all customer interactions accurately and maintain provider data.
• Utilize CRM platforms and Microsoft Office applications to meet KPIs.

Skills

Medical terminology

HIPAA compliance

Microsoft Office

Analytical skills

Communication

Education

High School Diploma or equivalent

Associate's or Bachelor's degree preferred

Job description

Proserve Business Consultancy Service is seeking a dedicated Administrative Services Specialist to support TPAs, health plans, and self-funded employers. The role focuses on delivering high-quality administrative and healthcare operations services while ensuring compliance with regulations and client requirements.

Responsibilities include member/provider support, enrollment processing, and coordinating authorization activities, with an emphasis on accuracy, efficiency, and quality of service in