Membership Service Advocate (N11)

Helpware Inc.; Cebu City; On-site; PHP 240,000 - 360,000; Full time

Benefits offered by this job

Healthcare benefits

Job summary

Helpware Inc. in Cebu City seeks a Member Services Advocate to transform customer service into superior Customer Care. You will assist beneficiaries with updating accounts, provide plan information, resolve issues, and advocate for customers while ensuring HIPAA compliance and high-quality service.

The role emphasizes attention to detail, empathy, and strong communication as you support members through complex benefits and utilization questions.

Qualifications

• Associate Degree or relevant healthcare-related education preferred.
• 3+ years in a fast-paced, high-volume call center environment (healthcare or hospitality preferred).
• Excellent written communication and problem-solving abilities.
• Ability to de-escalate situations calmly while maintaining professionalism.
• Strong attention to detail and ability to document customer interactions clearly.
• Proficiency with Microsoft Office and navigating multiple systems.
• Energetic phone presence and professional etiquette across calls, emails, and chats.

Responsibilities

• Update account information (billing, address, phone).
• Educate beneficiaries on plan benefits, coverage, and costs.
• Assist with eligibility, claims, and formularies as needed.
• Handle inbound/outbound calls with accuracy and efficiency.
• Escalate issues to management when necessary.
• Maintain high call quality and meet performance metrics.

Skills

Customer service

Active listening

Empathy

De-escalation

Multitasking

Communication

Attention to detail

Education

Associate Degree

Tools

Microsoft Office

Job description

About Us

Helpware is a technology-driven company with offices in the USA, Ukraine, Mexico, and the Philippines which provides Customer Experience & Operational Support for modern companies. Our team of professionals is driven by the purpose of providing best-in-class value-adding services to our partners by leveraging our empowered teams, innovative solutions, and technologies.

Position Summary:

As a Member Services Advocate, you will be a part of a team that transforms customer service into Customer Care by delivering an amazing experience. You will assist beneficiaries with a wide range of critical services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan. Qualified candidates will have a strong desire to help people with strong customer care skills, attention to detail, and highly organized.

Responsibilities:

As our customers share concerns and provide us with valuable feedback, your ability to recognize and complete the steps necessary to meet their needs will leave a permanent, lasting impression of the passion you have for helping them be at their best. We make sure our customers are not alone when it comes to understanding their benefits and they will rely on you to advocate for them as you would your own family member. In addition to the keys to success identified above that you will bring with you to the team, you will need to demonstrate the following abilities:

• Update account information such as billing options and changes of address or phone numbers.
• Research premium billing discrepancies and prescription claims processed.
• Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage.
• Submit mail requests for beneficiaries such as ID cards and formularies.
• Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why.
• Displays positive demeanor, technical accuracy, and conformity to company policies.
• Understands CMS Guidance and ensures applicable Exhibits are being mailed per CMS Guidance.
• Ensure HIPAA regulations are maintained within the immediate environment.
• Responsible for concise and detailed notations as it pertains to member records.
• Handles outbound calls for purposes of validating information.
• Handles inbound calls by assisting members with a high level of accuracy and efficiency.
• Escalates any member issues to management as necessary.
• Responsible for maintaining a high level of call quality as set by client standards, which includes a 95% quality score, and answering 80-85% of calls within 30 sec. or less
• Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.
• Conform with and abide by all regulations, policies, work procedures and instructions.
• Respond promptly when returning telephone calls and replying to correspondence and faxes.
• Act, dress, and behave in a professional manner to reflect a positive image of the company.

Monthly Goals:

• Meet average QA score of 95%
• Comply with attendance guidelines of 98%
• Schedule adherence of 90% or higher
• Maintain AHT below certain standards

Requirements:

• Associate Degree preferably in Healthcare
• Minimum 3 years working in a fast paced high volume call center environment, retail customer service, preferably in healthcare or hospitality
• Ability to multi-task effectively with strong attention to detail when documenting customers reasons for calling
• Excellent written communication skills
• Excellent problem-solving abilities - Must love customer service with excellent listening skills, demonstrate empathy and the ability to educate customers
• Ability to de-escalate matters in a calm and professional manner
• Comfortable with technology and navigating numerous systems simultaneously
• Unwavering dedication to serving a customer that has complex needs
• Requires strong technical skills with Microsoft Office (Excel, word, and Outlook)
• Must have an energetic phone presence - professional etiquette over the phone, through written and face to face communication
• Self-motivated, confident, reliable and commitment to customer satisfaction
• Adherence to following internal policy
• Ability to interact professionally and maintain effective working relationships with superiors, coworkers, customers, and others
• Ability to break down complicated information into simple messages for the caller