Field Customer Service Specialist 1

2 weeks ago

Manila, National Capital Region, Philippines Asalus Corporation (IntelliCare) Full time ₱300,000 - ₱450,000 per year

JOB PURPOSE

To delight customers by providing quality service through personalized assistance of members at the company premises or other assigned locations for any hmo related availments. Ensure proper implementation of the service level agreement and benefit plan of the members and contribute to client retention.

DUTIES & RESPONSIBILITIES

Build and establish good relationship with the client by giving accurate and timely assistance.

  • Act as help desk to companies by answering inquiries & concerns through hotlines, face to face and e-mails.
  • Issuance of RCS 1 and 2 within their Levels of Authority.
  • Providing approvals and/or disapprovals of the requested procedures.
  • Endorsement of members availment to facilities for outpatient and to assigned PRO for confinement.
  • Remind members in filing of Philhealth.
  • Conducts initial screening of reimbursement documents and give timely feedback on the following.
  • Status of file reimbursement.
  • Lacking documents.
  • Approved amount reimbursable.
  • Release date of approved reimbursement.

To ensure proper implementation of cost management initiatives within the company he/she is assigned to, to affect the company's bottom line.

  • Steering members to Cost Efficient facilities by following below process:
  • Referral to company doctors
  • Referral to Telemedicine (Medgate & TelAventus)
  • Aventus Clinics
  • Other cost-efficient clinics/providers and recommended panel of doctors.
  • Accredited Hospitals.
  • To prevent fraud and abuse of the members by following the adjudication process.

To ensure delivery of best customer experience to clients we serve and build loyalty and trust.

  • Coordinates with the different responsibility centers to escalate complicated concerns.
  • Issuance of Certificate of Coverage (COC).
  • Coordinate with ECU/APE team for the following.
  • Assists in setting of schedule.
  • Receives ECU/APE result and endorse to HR.
  • Monitors actual availment.
  • Sort and distribute received HMO cards.
  • Receive and screen documents for ID replacement request.
  • Transmittal of documents to the respective responsibility center.
  • Assist HR in accomplishing Philhealth documents.

QUALIFICATIONS

Educational Requirement 

Candidate must possess at least 4-year college degree in allied medical course. Undergraduate of allied medical course or graduate of any non-medical course maybe accepted.

Relevant Work Experience 

At least w/ experience as a customer service representative

Personal Characteristics and Behaviors 

Ability to work in a shifting schedule. Deal w/ different types of personalities and work under pressure. With pleasing personality. Attentive to details. Flexible and can work effectively under pressure

Required Competencies and proficiency levels 

Knowledge in medical terms, procedures and abbreviations, Computer literate. 

Good in oral & written Communication skills, Computer literate.

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