Insurance Benefits Processor

Job Description

Position: Eligibility Management Processor

Shift: Night

Under the direct supervision of the Supervisor, the Eligibility Management Processor is responsible for accomplishing data entry tasks in accordance with the client’s quality requirements and specifications.

1. Handles and analyzes Eligibility Management processing of cases in accordance with the client’s processes and specifications to meet the set targets and deliverables.
2. Ensures accuracy of encoded data such as but not limited to benefit enrollments (system & benefit carrier), benefit terminations (system & benefit carrier), and processing changes on customer’s benefit elections (system & benefit carrier) to maintain data integrity and quality.
3. Adheres to the channel’s standard operating procedures and work instructions to ensure work alignment across the channel.
4. Attends project orientation, job-related training, and/or other company-initiated training, when necessary, to continuously develop knowledge and skills.
5. Performs other requested tasks related to benefit processing to support the day-to-day operations of the business.
6. Ensures compliance to company rules and regulations, which shall include but not limited to the Employee Code of Discipline, the policies on Quality Management System (QMS), Information Security Management System (ISMS), Environment Health & Safety (EHS), and Environmental Management System (EMS); Data Privacy Act (DPA); and other duties and responsibilities prescribed for all employees.
7. Ensures compliance of all Non-Conformity Corrective Action Preventive Action Concessions (NCAPACs) and all other audit findings within the prescribed period.
8. Reports security incidents and/or any identified security weaknesses.
9. Performs other tasks that may be assigned from time to time.

Technical Competency (Learner): Applies the fundamental necessary skills to perform job duties; basic knowledge of conducting employee onboarding and other related training; knowledgeable of the business.

Technical Competency (Proficient): Proficient knowledge of Microsoft Office tools and can easily adjust to client tools; exceptional written and oral communication skills; typing skills of 200 CPM at 100% accuracy.

Results Orientation & Accountability (Learner): Takes full responsibility for completing tasks, follows established work routines, clarifies details as needed.

Problem Solving and Decision Making (Learner): Asks appropriate questions to define decisions to be made.

Critical Thinking (Learner): Gathers facts and analyzes data using systematic methods.

Organizational Awareness (Learner): Demonstrates understanding of the general environment in which the organization operates.

External Awareness (Learner): Keeps oneself updated of developments in other parts of the organization; and exhibits awareness of external realities.

Core Competencies

• Commitment to the Company’s vision and mission
• Customer Focus, Excellence, Respect, Teamwork, Integrity, Commitment (CERTIC)
• Excels at operating in a fast-paced and diverse environment.
• Demonstrated high professional and ethical standards.
• Personal Awareness (Learner). Maintains awareness of one’s emotions and uses this information to guide one’s thinking and actions in a favorable manner.
• Social Competence (Learner). Listens actively to people\'s concerns and acknowledges their situation and how they feel.
• Communicating Effectively (Learner). Listens actively and objectively to others individually or in groups.
• Collaboration (Learner). Takes personal responsibility for meeting agreed upon objectives; interacts and responds to broker partners and new acquisition when in the transfer process.
• Creativity & Innovation (Learner). Questions or challenges conventional work methods; uses new information to offer improvements.
• Graduate of any course
• Open to fresh graduates as long as with good communication skills
• Preferably with benefits administration/insurance experience or at least with experience in customer service and data entry in the BPO setting.
• At least 1 year of experience

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