CSR – Healthcare

PLEASE TAKE NOTE:

• Training period is 4-5 weeks in Cebu City starting November 17, 2025.
• Roundtrip flight tickets, accommodation, and per diem allowance will be provided.
• You will be a pioneering member of the Makati team.

Make your next big career move by applying as KMC Solutions' next CUSTOMER SERVICE REPRESENTATIVE

You will provide outstanding customer service to pharmacies, physicians, health plan sponsors, and their members, beneficiaries, or employees by responding to and resolving phone inquiries related to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes. Extent of supervision ranges from close to moderate based upon demonstrated skill and performance levels as defined for the position. This position is part of a two-level career path with progression opportunities described in the Core Service Career Path/Succession Planning Guidelines.

The main responsibilities of a CUSTOMER SERVICE REPRESENTATIVE include:

• Convey a positive image of the company by promptly responding to customer phone inquiries and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance.
• Deliver service that meets or exceeds department performance standards for Average Hold Time, Abandonment Rate, Talk Time, Quality, Adherence, and One-touch Resolution.
• Utilize multiple company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes. Use task route function, , and other processes & tools as applicable to escalate issues, request follow up action, or obtain assistance from other areas of the organization as necessary.
• Educate external customers about MedImpact's roles and responsibilities. Provide information about override guidelines, benefit plan restrictions, prior authorization requirements, grievance and appeal processes, and other PBM functions as specified by health plan sponsors in online CS Notes.
• Follow up with callers as appropriate to ensure customer satisfaction and timely response to requests. Diffuse irate or emotionally upset customers by appropriately listening to issues, calming the customer, and providing positive solutions to resolve concerns.
• Represent MedImpact in a positive manner by adhering to SMART processes and established procedures and guidelines. Support the department strategy by delivering Customer Service
• Excellence through telephone courtesy, prompt response to callers, anticipation of customer needs and concerns, solution-oriented problem solving, and adherence to call center scripts, greetings, and call closing messages.
• Identify opportunities and make recommendations to department leadership for improvement of workflow processes, operating systems, training programs, reference materials, and quality initiatives that enhance the customer experience.
• Keep current on new plan information and instructions by attending and participating in staff meetings, RTL's, company-required training programs, and other activities that develop skills, build teamwork, and provide updated information.
• Pharmacy Technician Certified CSR's support physician calls and can review Prior Authorization (PA)
  
  guidelines noted in the MedAccess system.

To apply, you must be an expert on the following requirements:

• Willing and able to undergo training in Cebu for 4-5 weeks starting on November 17, 2025
• Minimum 1 year of CSR experience supporting US, EU, or AU account.
• Excellent communication skills - neutral accent, decent grammar, and business-level spoken English proficiency.
• Reasoning Ability - Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
• Mathematical Skills -Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to interpret bar graphs.
• Customer and Quality Focus - Actively demonstrates a personal concern for understanding client needs, ensuring the quality of products and services, maintains a high level of customer satisfaction, and contributes to continuous improvement of products and processes.
• Interpersonal Effectiveness - Demonstrates good people skills by showing a commitment to teamwork, resolving conflicts effectively and with respect for others' viewpoints, respecting differences and building strong relationships and networks decision making and problem solving, constantly contributes positively as a team member, shares credit when appropriate and encourages teammates to use their knowledge and skills.
• Reliability - Maintains good record of attendance and punctuality, conscientiously follows through on actions without excessive need for supervision, fulfills commitments.
• Professionalism- Acts with integrity, shows self to be reliable and responsible, displays emotional intelligence, and conscientiously complies with all relevant laws, policies, and procedures.
• Quality Focus - Demonstrates a personal investment in ensuring the quality of products and/or services, going the extra mile to meet or exceed standards.
  
  Problem Solving - Analyzes problems logically to identify root causes, seeks input from a wide range of sources, asks insightful questions and formulates effective solutions.