Pooling: Healthcare CSR (Onsite) | Makati

Spoke; Makati; On-site; PHP 300,000 - 420,000; Full time

Job summary

Spoke in Metro Manila is establishing an in-house healthcare customer service function. We seek experienced Healthcare CSRs to assist members and providers with eligibility, benefits, claims, and provider searches, delivering a high-quality concierge service.

Candidates should have 3–5+ years in healthcare contact centers, strong English, HIPAA awareness, and be based in Metro Manila and ready to work in-office initially.

Qualifications

• 3–5+ years in healthcare customer service or healthcare call centers.
• Working knowledge of major U.S. health insurance carriers and plan structures.
• Excellent written and verbal English communication.
• Based in Metro Manila and able to work in-office to start.

Responsibilities

• Answer inbound calls from members and providers in a professional, customer-focused manner.
• Document every interaction, action taken, and follow-up item per procedures.
• Navigate multiple healthcare systems to research and resolve inquiries.
• Follow HIPAA guidelines and maintain confidentiality.
• Take ownership of provider concerns and aim for first-contact resolution.
• Escalate issues per the defined escalation process.
• Flag trends and potential improvements for the growing team.

Skills

Healthcare customer service

Strong English communication

HIPAA awareness

Multitasking across multiple systems

Documentation accuracy

Tools

CRM platforms

Ticketing systems

Call center platforms

Job description

About the role

The company is building an in-house customer support function for the first time. They're looking for experienced Healthcare Customer Service Representatives to provide support to their members and providers. This role is responsible for delivering a high-quality concierge experience by assisting with healthcare benefit questions, eligibility, claims inquiries, provider searches, and issue resolution.

Key responsibilities

• Answer inbound calls from members and providers in a professional, customer-focused manner.
• Support member and provider inquiries related but not limited to member eligibility verification, benefit coverage, claim status, provider network information, benefit coverage, member portal navigation, and general provider support.
• Accurately document every interaction, action taken, and follow-up item per established procedures.
• Navigate multiple healthcare systems and resources to research and resolve inquiries.
• Follow HIPAA guidelines and maintain strict confidentiality of member information.
• Take ownership of provider concerns and work toward first-contact resolution.
• Recognize issues that require escalation and follow the appropriate escalation process.
• Flag trends, process gaps, and improvement opportunities as the team builds its foundation.

As the team scales, responsibilities will expand to include member-facing calls covering benefit coverage, ID cards, provider network information, and member portal navigation.

What we're looking for

• 3-5+ years of healthcare customer service or healthcare call center experience.
• Working knowledge of major U.S. health insurance carriers (e.g., Aetna, Blue Cross Blue Shield) and plan structures.
• Excellent written and verbal English communication skills.
• Solid grasp of healthcare terminology: eligibility, benefits, claims, provider networks, and prior authorization basics.
• Comfortable multitasking across multiple systems while staying accurate and empathetic with callers.
• Strong attention to detail and documentation accuracy.
• Based in Metro Manila and available to work in-office to start.

Nice to have

• Prior experience with a health plan, TPA, insurance company, or benefits administrator.
• Member Services and/or Provider Services experience specifically.
• Self-funded health plan knowledge.
• Experience with CRM, ticketing, or call center platforms.

What success looks like

• A customer-first mindset paired with genuine empathy and professionalism.
• Strong problem-solving instincts and a bias toward ownership.
• Comfort operating in a growing, startup-like environment where processes are still taking shape.
• A willingness to learn new systems and help set the standard for teammates who join later.
• Startup-ready mindset and attitude, comfortable with ambiguity, fast change, and building processes from scratch.