Healthcare Training & Operations Architect

The Philippine Operations Center Global Solutions Inc.; Central Visayas; On-site; PHP 558,000 - 893,000; Full time

Job summary

The Philippine Operations Center Global Solutions Inc. is seeking a Healthcare Trainer & Operations Specialist to design, deliver, and facilitate onboarding and nesting programs for US health insurance agents.

When training needs arise, you will also support customer-facing operations to maintain line proficiency and meet SLAs. During non-training periods, you will handle inbound/outbound calls for eligibility, claims, and prior authorization while adhering to HIPAA and quality standards.

Qualifications

• Minimum of 2 years of operational experience in a US Healthcare / Health Insurance call center account, with at least 1 year of experience as a Trainer, SME, or Nesting Coach.
• Strong understanding of US health insurance concepts (deductibles, copays, coinsurance, OOP max, claim adjudication, EOBs, CPT/ICD-10 coding awareness).
• Excellent verbal and written English communication skills with presentation capabilities.
• Ability to pivot between classroom facilitation and phone queue operations based on business demands.
• Proficiency in MS Office and familiarity with CRM and call-handling software.

Responsibilities

• Facilitate end-to-end training programs for new hires and cross-training cohorts covering US Health Insurance fundamentals (HIPAA, ACA, Medicare/Medicaid, Claims Processing, Billing, and Appeals).
• Conduct system navigation training on client CRM systems, clearinghouses, and claim portals.
• Lead the Nesting phase, providing real-time coaching, side-by-side feedback, and call evaluation.
• Update training materials, job aids, and knowledge base articles to reflect changing insurance policies and client guidelines.
• Measure agent progress through daily quizzes, operational readiness assessments, and performance scorecards.
• Handle inbound and outbound calls during non-training periods to support daily queue volume and target KPIs.
• Assist health plan members and healthcare providers with eligibility, benefits verification, claim status, and prior authorization requests.
• Adhere strictly to HIPAA guidelines, patient privacy rules, and internal quality standards during call handling.
• Maintain top-tier individual metrics (AHT, CSAT, FCR, and Quality Assurance scores) to set a performance benchmark for the team.

Skills

Healthcare training

Call center operations

US Health Insurance

Nesting coaching

Tools

MS Office

CRM software

Call-handling software

Job description

The Philippine Operations Center Global Solutions Inc. is seeking a Healthcare Trainer & Operations Specialist to design, deliver, and facilitate onboarding and nesting programs for US health insurance agents.

When training needs arise, you will also support customer-facing operations to maintain line proficiency and meet SLAs. During non-training periods, you will handle inbound/outbound calls for eligibility, claims, and prior authorization while adhering to HIPAA and quality standards.