Member Care Supervisor

Medicare Plus Inc.; Vincenzo A. Sagun; On-site; PHP 335,000 - 502,000; Full time

Benefits offered by this job

Health insurance

Opportunities for promotion

Job summary

Medicare Plus Inc. is seeking a Customer Care Specialist to handle member inquiries with empathy and accuracy. You will manage inbound/outbound calls, LOA creation, and claims status updates, coordinating with the Claims Department for verified information.

Channel coverage includes email and Viber, with strict adherence to response times and escalation protocols. You will document interactions in the system, participate in coaching, and support team adherence to processes and quality standards

Qualifications

• Handle inbound member calls with active listening and empathy.
• Accurately log inquiries and update case tracker with verified info.
• Escalate complex issues to floor lead promptly.

Responsibilities

• Receive and handle inbound member calls professionally.
• Conduct outbound follow-up calls and fulfill callbacks.
• Manage inquiries via email and messaging channels (e.g., Viber).
• Provide accurate information on benefits, coverage, and claims status.
• Escalate irate or complex cases to designated team members.
• Create LOAs for member consultations and approvals.
• Process APE and Dental benefit availments with providers.
• Support discharge coordination workflows with LOA and coverage details.
• Log into telephony system and maintain queue readiness at shift start.
• Maintain after-call work documentation within the time window.
• Adhere to timekeeping and break policies; participate in team activities.

Skills

Active listening

Empathy

Communication

Tools

PAB telephony system

HRIS

Job description

Job description:

Performs structured, supervised member-facing work across defined workstreams, building deeper competency in MPI systems, benefit structures, and service standards under regular supervisory guidance.

Your duties include, but are not limited to the following:

Receive and handle inbound member calls professionally, applying active listening, empathy, and AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You) communication

standards in every interaction.

Conduct outbound follow-up calls to members as assigned, including callback fulfillment for missed calls and resolution follow-throughs.

Manage member inquiries received through email and messaging channels (e.g., Viber) in compliance with FIFO processing protocols and departmental response-time standards.

Provide accurate, verified information on MPI member benefits, coverage, accredited providers, and claims status; refrain from providing estimates or information not confirmed by official sources or case owners.

Escalate calls that exceed standard handling scope — including irate members, clinical edge cases, and complex benefit disputes — to the designated floor lead or Member Care Specialist without delay.

Create Letters of Authorization (LOAs) for member consultations, procedures, confinements following established MPI authorization protocols and within approved timelines.

Process Annual Physical Examination (APE) and Dental benefit availments, coordinating with accredited providers as needed.

Support discharge coordination workflows as assigned, providing members and healthcare facilities with accurate LOA, coverage, and processing information.

Escalate ER Guard emergency pre-authorization concerns to the designated ER Guard-assigned team member or Member Care Specialist immediately.

Receive and log member inquiries related to reimbursement claims, hospitalization benefits, and claim processing status.

Coordinate with the Claims

Department to relay accurate, confirmed status updates to

members, referencing the inter-departmental case tracker for verified information.

Provide members with a reference or ticket number for their inquiry and document all communication accurately in the system.

Escalate unresolved, aging, or irate claims concerns to the floor lead or Specialist per the defined escalation timeline.

Log in to the PAB telephony system and confirm queue readiness within the required timeframe at the start of each shift and immediately upon returning from approved break periods.

Maintain accurate after-call work documentation within the prescribed after-call time window.

Adhere to the daily workforce assignment plan, executing the assigned workstream - inbound calls, outbound calls, LOA creation, or email/Viber-as directed by the floor lead or supervisor.

Comply fully with timekeeping requirements: clock in and out for the meal break via the HRIS biometric system, adhere to the two-break limit per shift, and never proceed to a break immediately after clocking in.

Observe all workplace conduct standards including the personal device restriction and work-only internet policy while on the operations floor.

Participate actively in team huddles, training sessions, competency reassessments, and coaching conversations.

Flag recurring member concerns, system issues, or process gaps to the floor lead to support continuous improvement.

Support team capacity during high-volume periods as directed, including temporary redeployment to inbound calls from other workstreams.

Benefits:

• Health insurance
• Opportunities for promotion

Work Location: In person