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Healthcare Account Representative

2 weeks ago

Makati City, National Capital Region, Philippines ISTA Solutions Full time
About the Role
As a Customer Service Representative for Healthcare Account SPX, you will play a vital part in ensuring seamless communication between healthcare providers and patients. Your primary responsibility will be to test claims for medication coverage, verifying that prescribed medications are covered by insurance plans.

Key Responsibilities include:
  • Test Claims for Medication Coverage:
    • Verify if prescribed medications will be covered by the insurance plan
    • Identify discrepancies between the prescribed medication and the coverage available under the individual's insurance
  • Communication with Facilities:
    • Establish effective communication with medical facilities regarding medications not covered by insurance
    • Provide facilities with alternative medication options and necessary steps to proceed with the claims process
  • Interaction with Pharmacy Representatives:
    • Maintain liaison with Registered Pharmacists (RPH) for recommendations on alternative medications when a prescribed drug is not covered
    • Gather information regarding dosages, application methods, and instructions for alternative medications to ensure proper patient care
  • Documentation and Reporting:
    • Maintain detailed records of communication with healthcare providers, pharmacies, and patients regarding medication coverage and alternative options
    • Keep a log of all claims tested, outcomes, and follow-up actions taken


About You
We are looking for a skilled professional who can work effectively in a fast-paced environment, providing excellent customer service and resolving complex issues. The ideal candidate should possess good verbal and written English skills, with the ability to work independently and as part of a team.

Required Skills and Qualifications include:
  • A minimum of 6 months back office experience
  • Good email management skills
  • No prior BPO experience required
  • Excellent verbal and written communication skills
  • Ability to work night shifts
  • Willingness to work in a dynamic environment


About ISTA Solutions
ISTA Solutions is a leading outsourcing/offshoring company committed to creating a culture focused on long-term success and life-long learning. We offer a competitive salary and benefits package, including health insurance with free dependents, a 10%-night differential, attendance bonus, paid time off, and convertible leave credits.