Membership Service Advocate

2 days ago

Cebu City, Central Visayas, Philippines Helpware Full time ₱23,000 - ₱260,000 per year

Position Summary:

As a Member Services Advocate, you will be a part of a team that transforms customer service into Customer Care by delivering an amazing experience. You will assist beneficiaries with a wide range of critical services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan. Qualified candidates will have a strong desire to help people with strong customer care skills, attention to detail, and highly organized.

Responsibilities:

As our customers share concerns and provide us with valuable feedback, your ability to recognize and complete the steps necessary to meet their needs will leave a permanent, lasting impression of the passion you have for helping them be at their best. We make sure our customers are not alone when it comes to understanding their benefits and they will rely on you to advocate for them as you would your own family member. In addition to the keys to success identified above that you will bring with you to the team, you will need to demonstrate the following abilities:

  • Update account information such as billing options and changes of address or phone numbers.
  • Research premium billing discrepancies and prescription claims processed.
  • Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage.
  • Submit mail requests for beneficiaries such as ID cards and formularies.
  • Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why.
  • Displays positive demeanor, technical accuracy, and conformity to company policies.
  • Understands CMS Guidance and ensures applicable Exhibits are being mailed per CMS Guidance.
  • Ensure HIPAA regulations are maintained within the immediate environment.
  • Responsible for concise and detailed notations as it pertains to member records.
  • Handles outbound calls for purposes of validating information.
  • Handles inbound calls by assisting members with a high level of accuracy and efficiency.
  • Escalates any member issues to management as necessary.
  • Responsible for maintaining a high level of call quality as set by client standards, which includes a 95% quality score, and answering 80-85% of calls within 30 sec. or less
  • Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.
  • Conform with and abide by all regulations, policies, work procedures and instructions.
  • Respond promptly when returning telephone calls and replying to correspondence and faxes.
  • Act, dress, and behave in a professional manner to reflect a positive image of the company.

Monthly Goals:

  • Meet average QA score of 95%
  • Comply with attendance guidelines of 98%
  • Schedule adherence of 90% or higher
  • Maintain AHT below certain standards

Job Types: Full-time, Permanent

Pay: Php23, Php26,000.00 per month

Ability to commute/relocate:

  • Cebu: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

  • What's your previous and expected salary?
  • Can you start August 26?

Experience:

  • CSR: 1 year (Preferred)

Work Location: In person

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