Membership Service Advocate (N4)

Helpware Inc.; Cebu City; On-site; PHP 279,000 - 391,000; Full time

Job summary

Helpware Inc. in Cebu City is seeking a Member Services Advocate to transform customer service into proactive care, assisting beneficiaries with plan information, account updates, and issue resolution with accuracy and empathy.

You will research billing and formulary details, educate members on benefits and copays, and provide clear, concise notes while meeting quality targets and compliance standards.

Qualifications

• Associate degree preferably in Healthcare.
• Minimum 3 years in a fast-paced high-volume call center environment.
• 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 empathy and listening skills.
• Ability to de-escalate matters in a calm and professional manner.
• Comfortable with technology and navigating numerous systems simultaneously.
• Strong technical skills with Microsoft Office (Excel, Word, Outlook).
• Energetic phone presence and professional etiquette over the phone, via written communication.
• Self-motivated, reliable and committed to customer satisfaction.
• Adherence to internal policy.
• Ability to interact professionally with superiors, coworkers, customers, and others.

Responsibilities

• 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 coverage, tier and copay levels, and explain if a drug is not covered.
• Displays positive demeanor, technical accuracy, and conformity to company policies.
• Understands CMS Guidance and ensures Exhibits are mailed per CMS Guidance.
• Ensure HIPAA regulations are maintained within the environment.
• Responsible for concise and detailed notations in member records.
• Handle outbound calls for information validation.
• Handle inbound calls assisting members with accuracy and efficiency.
• Escalate member issues to management as necessary.
• Maintain a high level of call quality per client standards (95% QA) and answer 80-85% of calls within 30 sec.
• Communicate professionally with coworkers, management, staff, customers, and others.
• Conform with and abide by all regulations, policies, work procedures and instructions.
• Respond promptly to calls and correspondence.
• Act professionally to reflect a positive image of the company.

Skills

Attention to detail

Excellent communication

Problem solving

Empathy

Active listening

De-escalation

Technical skills (MS Office)

Multitasking

Phone presence

Education

Associate Degree in Healthcare

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