URGENT HIRING! CLINIC RECEPTIONIST (CSS1)- INTELLICARE

Asalus Corporation (IntelliCare); Philippines; On-site; PHP 201,000 - 312,000; Full time

Job summary

Asalus Corporation (IntelliCare) is seeking a Customer Service Specialist 1 to review and approve members' requests for consultations and procedures based on healthcare benefits. You will provide member support, answer inquiries, and ensure requests are processed accurately in accordance with benefit plan coverage, contributing to customer satisfaction and client retention.

Responsibilities include handling inquiries, processing requests, verifying eligibility and coverage, and maintaining

Qualifications

• Graduate or undergraduate in Allied Medical field or with a Bachelor’s degree and at least 6 months in HMO industry.
• Experience in HMO or healthcare setting is advantageous.
• Strong written and oral communication skills.
• Patient and empathetic with members, providers, and colleagues.
• Ability to multitask and work under pressure.
• Willing to learn and adapt to process changes.
• Willing to work shifting schedules (morning, mid, night).
• Strong problem solving and judgment to resolve service concerns.

Responsibilities

• Answer inquiries from members, providers, and facilities regarding benefits, coverage, and procedures.
• Review and process requests for consultations, procedures, and services based on benefit plans.
• Verify member information, eligibility, coverage, doctors and facilities, and applicable limits before approvals.
• Ensure approvals follow company policies, guidelines, and authority levels.
• Maintain accurate records of transactions, approvals, inquiries, and activities.
• Identify potential abuse or fraud and report to the appropriate heads for investigation.
• Deliver excellent customer service to promote member satisfaction and retention.

Skills

Communication

Empathy

Multitasking

Typing 45 WPM

Computer literacy

Attention to detail

Education

Allied Medical Course background or Bachelor's Degree

Tools

MS Office

Job description

About the role

The Customer Service Specialist 1 reviews and approves members' requests for consultations and procedures based on their healthcare benefits, particularly for Outpatient and Dental services. The role provides member support, answers inquiries, and ensures requests are processed accurately in accordance with benefit plan coverage, contributing to customer satisfaction and client retention.

Key responsibilities

• Answer inquiries from members, healthcare providers, and accredited medical facilities regarding healthcare benefits, coverage, and availment procedures.

• Receive, review, and process requests for consultations, procedures, and other healthcare services based on members' benefit plans.

• Verify member information, eligibility, benefit coverage, accredited doctors and facilities, and applicable limits before issuing approvals.

• Ensure that all approvals are processed in accordance with company policies, benefit guidelines, and established levels of authority.

• Maintain accurate and complete records of transactions, approvals, inquiries, and related activities.

• Identify potential abuse, misuse, or fraudulent claims and immediately elevate and report such cases to the appropriate department heads for investigation.

• Deliver excellent customer service to promote member satisfaction and contribute to client retention.

About you

• Graduate or undergraduate of any Allied Medical Course; or Graduate or undergraduate of any Bachelor's Degree with at least six (6) months of experience in the HMO industry.

• Experience in an HMO setting, healthcare industry, or medical facility is an advantage.

• Effective communication skills in both oral and written formats.

• Patient and empathetic in dealing with members, providers, and colleagues.

• Ability to multitask and work efficiently under pressure.

• Willingness to learn and adapt to changes in processes and procedures.

• Willing to work on shifting schedules (morning, mid, and night shifts).

• Strong critical thinking and problem-solving skills to analyze and resolve customer service concerns while exercising sound judgment and initiative.

• Computer literate and proficient in basic office applications.

• Typing speed of at least 45 words per minute (WPM).