Staff Nurse

Qualifications:

• Graduate of a medical-allied course (e.g., Nursing, Medical Technology, Pharmacy, Physical Therapy, Radiologic Technology, etc.).
• Must have completed a clinical internship with hands-on experience in a hospital, clinic, or healthcare facility during college.
• Strong communication and interpersonal skills.
• Willing to work onsite and on shifting schedules.
• Fresh graduates with relevant clinical internship experience are encouraged to apply.

Responsibilities:

• Respond to customer inquiries regarding healthcare plans, benefits, coverage, and other related services through phone, email, or chat.
• Provide accurate, timely, and professional assistance to members, healthcare providers, and clients.
• Verify member eligibility, benefits, and policy information.
• Coordinate with hospitals, clinics, physicians, and other healthcare providers regarding member concerns and requests.
• Assist in processing authorizations, referrals, and claims-related inquiries in accordance with company policies.
• Document customer interactions accurately and maintain complete records in the system.
• Resolve customer concerns and complaints while ensuring a high level of customer satisfaction.
• Ensure compliance with company policies, healthcare regulations, and data privacy standards when handling confidential information.
• Escalate complex cases to the appropriate department for immediate resolution.
• Maintain productivity and quality standards while delivering excellent customer service.
• Stay updated on healthcare policies, HMO products, and company procedures through continuous training.
• Perform other duties and responsibilities that may be assigned by management.