Customer Service Representative – Healthcare Insurance

Job Description Customer Service Representative – Healthcare Insurance & Claims Specialist Are you passionate about helping people navigate their healthcare insurance and claims? As a Customer Service Representative – Healthcare Insurance & Claims Specialist, you will be the first point of contact for customers, assisting them with insurance inquiries, claims processing, and policy details. Your expertise will ensure that customers receive the support they need to understand their benefits and resolve any concerns effectively. Key Responsibilities Handle inbound and outbound customer inquiries related to healthcare insurance, claims, and policy coverage. Assist customers with filing claims, understanding Explanation of Benefits (EOB), and resolving billing discrepancies. Verify customer information, eligibility, and coverage details using internal systems. Provide accurate and timely responses to inquiries about deductibles, co-pays, out-of-pocket expenses, and provider networks. Escalate complex issues to appropriate departments while ensuring timely follow-up and resolution. Educate customers about plan benefits, claim submission processes, and appeals procedures. Maintain detailed and accurate records of customer interactions using CRM tools. Ensure compliance with HIPAA and other healthcare regulations. Work collaboratively with internal teams, including claims processors and underwriters, to resolve issues efficiently. Meet or exceed customer satisfaction and performance metrics. Qualifications Previous experience in healthcare insurance, medical claims, or customer service (preferably in a call center or claims processing environment). Strong knowledge of medical billing, insurance terminology, and claims adjudication. Excellent communication and problem‑solving skills with a customer‑centric approach. Ability to multitask and navigate multiple systems while assisting customers. Understanding of HIPAA compliance and patient confidentiality. High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration or a related field is a plus. Experience with claims processing software, CRM systems, or insurance databases is preferred. Ability to work flexible shifts, including evenings and weekends if required. Why apply with us? Competitive Compensation package with Salary Appraisals Saturday‑Sunday Off Equipped with the latest technologies Monthly Incentive Rewards on successful orders and Attendance Productivity Offers Full‑time employment and Career Growth Easily accessible from almost any part of the Metro Cebu area. One‑day Application Process only Service Incentive Leaves Upon Regularization Attendance Productivity Incentives Additional Hazard Pay within Qualifying Hours Stable Job with Salary Appraisals Holiday and Night Differential Premium Pay Rates Job Promotion is highly possible… if YOU have the drive. HMO/Health Insurance Work‑Life Balance Free Pre‑hiring Medical Laboratories Free Coffee Company Overview Staff Outsourcing Solutions, is an offshoring and outsourcing solutions provider based in Cebu. We enable foreign businesses to reduce costs, increase flexibility, and extend their global output by providing the most efficient ways we deliver our services. Our unique approach with dedication and commitment effectively removes the stress and conflict that would normally exist in businesses that are consistently keeping up with today's global demands. Staff Outsourcing Solutions firmly believes in being transparent to its clients to apply effective ways to deliver results that extend your global reach. The variety of services we offer that targets specific market segments makes us a reliable and long‑term solid partner to our clients. The opportunities we provide enabled us to serve several business organizations ranging from small start‑ups to mid‑size multinationals. With the core competencies of our professional workforce with excellent proficiency in English and flexible services, Staff Outsourcing Solutions is the right partner as an offshore and BPO solutions provider. Overview Staff Outsourcing Solutions specializes in hosting, setting up, and managing offshore business operations in the Philippines on behalf of our clients from all over the world. Through offshoring business processes, our clients drastically reduce operational costs, increase flexibility, expand the reach on their operations globally, meet the increasing demand, and provide quality solutions around the world. The unique services we cater to our client's needs adapt to their specific needs. Staff Outsourcing Solutions has been flexible in offering services to different foreign business organizations, from small and medium‑size businesses to large multinational corporations. Contact Information Website: Facebook Page: Instagram: @staffoutsourcingsolutions LinkedIn: #J-18808-Ljbffr