Member Services Representative

1 week ago

Manila, National Capital Region, Philippines Imagenet Phils., Inc. Full time

Apply Today Don't delay, qualified candidates will be reviewed on a rolling basis. Job Description: Member Services Representative (Healthcare)

Position Overview:

Join our team as a Member Services Representative (Healthcare), where you will play a crucial role in taking member services calls in relation to policy management, benefits and claim inquiries. You will be a valued member of the team, providing exceptional customer service to our clients and members by ensuring their satisfaction on calls. As a key contributor, you will be responsible for accurately and efficiently reading and relaying information to members. This position requires a solid understanding of the healthcare claims, benefits and policy process flows and expertise in healthcare/medical terminology, including ICD-9 and ICD-10 coding. Key Responsibilities:

Policy Management

Billing: Process member payments, address billing inquiries, and resolve billing discrepancies.Member Information Updates: Update member information accurately and promptly, including addresses, phone numbers, beneficiaries, and employment details.Policy Terminations and Reinstatements: Handle policy termination requests, process policy terminations effectively, and assist with policy reinstatements.ID Card Ordering: Process ID card orders efficiently, ensure timely delivery, and address any ID card-related concerns.

Benefits

Coverage Information: Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions.Prior Authorization and Referrals: Assist members with prior authorization and referral processes, guiding them through the procedures and requirements.Healthcare Provider Contact Research: Conduct thorough research to locate contact information for healthcare providers, ensuring accurate and up-to-date information for members.

Claims

Claims Status Updates: Provide accurate and timely status updates on claims, explaining the processing stages and addressing any concerns.Claims Inquiries: Answer questions about claim processing, explaining claim denials, and providing guidance on submitting appeals.Claims Reconsideration Requests: Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals.

General Inquiry

Website Troubleshooting: Assist members with troubleshooting issues related to the member website, guiding them through navigation and resolving technical problems.General Questions: Answer general questions about health insurance plans, providing comprehensive and accurate information on various topics.

Additional Responsibilities

Maintain Confidentiality: Adhere strictly to confidentiality policies and safeguard sensitive member information.Escalate Complex Issues: Escalate complex issues to supervisors or managers for further assistance and resolution.Continuous Learning: Stay updated on changes in health insurance regulations, policies, and procedures.Contribute to Team Success: Collaborate effectively with team members to achieve shared goals and maintain a positive work environment. Preferred Experience: An education level of at least college undergrad for 2 years.At least 2 years of BPO Healthcare exp (Voice) - involving member/patient servicesIn-depth knowledge (Healthcare terminologies, Eligibility, Benefits, Claims, ICD-9 and ICD-10 coding, Policy Process flow) is required.Strong computer experience (data entry, screen navigation, keyboarding),Excellent customer service skillsAbility to adhere to daily schedules and duties.Excellent oral and written communication skills Excellent demonstration of caring and compassionMulti-task along with attention to detail Self-motivation, organized, time-management and deductive problem-solving skills Work independently and as part of a team Requirements:Call Center/BPO Experience is a mustAmenable to work on graveyard shift, holidays or weekends if required. Candidate residing in Manila or nearby provinces is preferred.Dedicated workspace suitable for remote work Stable internet connection not less than 35mbps Can start immediately. This is an urgent hiring need Additional Benefits:13th Month PayTransportation AllowanceHMO (medical and dental coverage) IMPORTANT:

**Only those applications who have prior experience in Healthcare Account will be considered for the next step of recruitment process.

Application Letter: (Required)

Along with your CV, include short application letter providing our recruitment team a snapshot of why you are qualified for this specific role and answering the following questions:

How do you keep yourself updated with latest trends in Healthcare Industry?How can your experience help you succeed in this role? *** Kindly prepare these non-negotiable requirements such as: SSS, TIN, Pag-ibig, PhilHealth numbers, Transcript of records.

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