TPA Administrative Services Specialist

Proserve Business Consultancy Service; Cebu City; On-site; PHP 180,000 - 360,000; Full time

Job summary

Proserve Business Consultancy Service is seeking a dedicated Administrative Services Specialist to support TPAs, health plans, and self-funded employers. The role focuses on delivering high-quality administrative and healthcare operations services while ensuring compliance with regulations and client requirements.

Responsibilities include member/provider support, enrollment processing, and coordinating authorization activities, with an emphasis on accuracy, efficiency, and quality of service in

Qualifications

• High School Diploma or equivalent required.
• Associate's or Bachelor's degree preferred.
• 2+ years of healthcare administration, customer service, health insurance, or revenue cycle experience.
• TPA, payer or provider experience.
• Contact center experience preferred.

Responsibilities

• Provide exceptional customer service to members, providers, employer groups, and plans.
• Assist members with benefits, eligibility, enrollment, claims status, ID cards.
• Support providers with payment inquiries, demographic updates, credentialing, and issue resolution.
• Process eligibility, enrollment, terminations, and coverage changes accurately.
• Support claims administration activities (non-adjudication).
• Coordinate prior authorization and pre-certification support.
• Document all customer interactions accurately and maintain provider data.
• Utilize CRM platforms and Microsoft Office applications to meet KPIs.

Skills

Medical terminology

HIPAA compliance

Microsoft Office

Analytical skills

Communication

Education

High School Diploma or equivalent

Associate's or Bachelor's degree preferred

Job description

On-site - Cebu 1-3 Yrs Exp High/Senior High School Full-time

Job Description

TPA

Administrative Services Specialist

is seeking a highly motivated and customer-focused TPA Administrative Services

Specialist to support Third-Party Administrators (TPAs), health plans,

self-funded employers. This role serves as an extension of clients' operations

by delivering high-quality administrative, customer support, and healthcare

operations services across multiple functional areas.

The ideal candidate is detail-oriented, adaptable, and committed to delivering

exceptional service while maintaining compliance with healthcare regulations,

client requirements, and operational performance standards. Team members will

Essential Duties and Responsibilities

Provide exceptional customer service to members, providers, employer groups, and

Assist members with benefits, eligibility, enrollment, claims status, ID cards, and

Support providers with payment inquiries, demographic updates, credentialing support,

and issue resolution.

Process eligibility, enrollment, terminations, and coverage changes accurately.

Support claims administration activities (non-adjudication).

Coordinate prior authorization and pre-certification support.

Request, organize, and validate medical records and supporting documentation.

Support care management, utilization management, and case management activities.

Maintain provider directories and provider data.

Support employer group administration and benefit changes.

Document all customer interactions accurately.

Utilize payer systems, CRM platforms, and Microsoft Office applications.

Meet productivity, quality, turnaround time, and customer satisfaction goals.

Recommend workflow improvements.

Collaborate with internal teams and client stakeholders.

Participate in training and quality initiatives.

Perform additional healthcare administrative duties as assigned.

Qualifications

Education

High School Diploma or equivalent required.

Associate's or Bachelor's degree preferred.

Experience

2+ years of healthcare administration, customer service, health insurance, or revenue cycle experience.

TPA,payer or provider experience.

Contact center experience preferred.

Knowledge, Skills and Abilities

Medical terminology

Healthinsurance

Eligibility & enrollment

Member and provider services

HIPAA compliance

Microsoft Office

Analytical and problem-solving skills

Strong communication

Key Performance Indicators (KPIs)

Quality Assurance

Productivity

Documentation Accuracy

Schedule Adherence

Customer Satisfaction

HIPAA Compliance

Core Competencies

Customer Focus

Professionalism

Accountability

Integrity

Teamwork

Critical Thinking

Communication

Working Conditions

Office-based or remote depending on assignment.

Flexible schedules as required.

Prolonged computer use.

Frequent interaction with members, providers, and employer groups.

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