Key Responsibilities

• Respond to inbound inquiries regarding healthcare benefits, eligibility, claims status, and account information.

• Assist patients and members in understanding healthcare plans, coverage details, and policy guidelines.

• Resolve billing concerns, payment issues, and account discrepancies.

• Document all interactions, requests, and resolutions in the system accurately.

• Coordinate with internal departments, insurance carriers, or healthcare providers to resolve complex concerns.

• Follow HIPAA, privacy, and compliance regulations when handling sensitive health information.

• Meet performance metrics including quality, productivity, and customer satisfaction targets.

• Provide first-call resolution whenever possible.

• Educate customers on available services, processes, and self-service options.

Qualifications

• SHS Graduate or Bachelor's Degree Graduate (Must have a diploma and TOR).

• Experience in healthcare customer service, BPO, or call center operations is preferred.

• Knowledge of healthcare insurance processes, claims handling, or medical terminology is a plus.

• Strong verbal and written communication skills.

• Ability to handle difficult customers with professionalism and empathy.

• Basic computer navigation and data entry skills.

Skills and Competencies

• Customer service and conflict resolution

• Attention to detail and accuracy

• Active listening and problem-solving

• Time management and multitasking

• Healthcare process knowledge