Healthcare Customer Service Representative

Imagenet Phils., Inc.; Philippines; On-site; PHP 279,000 - 446,000; Full time

Benefits offered by this job

Comprehensive HMO Coverage - Medical &

HMO coverage on Day 1 plus 1 dependent

Job summary

Imagenet is seeking a Healthcare Customer Service Advocate to support U.S. healthcare members by handling benefits inquiries, eligibility verification, and medical claims processing in a high-volume BPO environment.

The role requires strong healthcare knowledge, urgency, and accuracy, with emphasis on HIPAA compliance and excellent English communication. Training is provided, with opportunities to grow within a technology-forward healthcare operations partner.

Qualifications

• High school diploma or equivalent; college degree preferred.
• Minimum 2 years' experience in healthcare BPO, call center, or healthcare customer service.
• Working healthcare knowledge of benefits, eligibility, and medical claims processing.
• Strong English communication, active listening, and multitasking skills.
• High attention to detail and discretion with sensitive information.
• Able to perform in a high-volume, deadline-driven environment.
• Familiarity with Medicare processes and patient care protocols is a plus.
• Experience supporting Medicare members/patients.
• Familiarity with ICD-9/ICD-10 coding.

Responsibilities

• Answer inbound calls and chats from customers including providers, health plans, insurance brokers, and hospitals in accordance with HIPAA guidelines.
• Provide accurate information about coverage plans, including eligibility, benefits, limitations, and exclusions.
• Coordinate resolution of service issues by interfacing with other departments.
• Maintain product knowledge and stay updated on industry trends.
• Manage a high volume of incoming claims with strict deadlines.
• Investigate claims by reviewing policy details, medical records, and documentation.
• Determine claim eligibility, liability, and payout amounts per policy terms.
• Communicate with claimants, providers, and internal stakeholders.
• Assist members with reconsideration requests for denied claims and supporting documentation.
• Document interactions, issues, and resolutions in the systems.

Skills

English communication

Active listening

Multitasking

Attention to detail

Deadline-driven

Medicare knowledge

ICD-9/ICD-10 coding

Healthcare BPO experience

Call center experience

Education

High school diploma or equivalent

College degree preferred

Job description

About the role

As a Healthcare Customer Service Advocate, you will support U.S. healthcare members by handling benefits inquiries, eligibility verification, and medical claims processing. This role requires strong healthcare knowledge, urgency, and accuracy in a high-volume BPO environment.

Key responsibilities

• Answer inbound calls and chats from customers including providers, health plans, insurance brokers, and hospitals in accordance with HIPAA guidelines
• Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions
• Coordinate complete resolution of service issues by interfacing with other departments including Eligibility, Benefits, Claims and any other departments internally
• Maintain a high level of product knowledge and stay updated on industry trends
• Manage a high volume of incoming claims while adhering to strict deadlines
• Conduct thorough investigations of claims by reviewing policy details, medical records, and supporting documentation
• Determine claim eligibility, liability, and appropriate payout amounts based on policy terms and industry guidelines
• Communicate effectively with claimants, healthcare providers, and internal stakeholders
• Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals
• Document customer interactions, issues, and resolutions in the appropriate systems

About you

• High school diploma or equivalent; college degree preferred
• Minimum 2 years' experience in healthcare BPO, call center, or healthcare customer service
• Working healthcare knowledge of benefits, eligibility, and medical claims processing
• Strong English communication, active listening, and multitasking skills
• High attention to detail and discretion when handling sensitive information
• Able to perform in a high-volume, deadline-driven environment
• Familiarity with Medicare processes and patient care protocols is a plus
• Experience supporting Medicare members/patients
• Familiarity with ICD-9/ICD-10 coding

Benefits

• Comprehensive HMO Coverage - Medical & Dental
• HMO coverage on Day 1 plus 1 dependent

About Imagenet

Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients.

Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve.

Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines.

Joining Imagenet means contributing to work that supports the healthcare operations members and providers rely on every day.