Healthcare Customer Service Agent

6 days ago

Cebu City, Central Visayas, Philippines KMC Solutions Full time ₱900,000 - ₱1,200,000 per year

Job Overview:

  • On-site a Cebu Exchange Tower
  • Fixed night shift
  • Minimum of 3 years proven experience in a customer service or client support role, preferably in a high-volume or BPO/contact center environment.

The main responsibilities of a CUSTOMER SERVICE REPRESENTATIVE I 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 company'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 company 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 system.

Qualifications:

  1. Minimum of 3 years proven experience in a customer service or client support role, preferably in a high-volume or BPO/contact center environment.
  2. Excellent verbal and written communication skills in English, with the ability to convey information clearly, professionally, and empathetically.
  3. Demonstrated ability to handle complex customer inquiries with professionalism, patience, and problem-solving skills.
  4. Strong active listening skills and a customer-first attitude.

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