Medical Representative

Job Summary

We are looking for a dedicated and customer-oriented Healthcare Customer Service Representative to join our team. In this role, you will assist members, healthcare providers, and clients with inquiries related to healthcare benefits, insurance coverage, claims, billing, eligibility, and other account-related concerns. The ideal candidate is an excellent communicator with strong problem-solving skills and a passion for delivering exceptional customer service.

Key Responsibilities

• Handle inbound and outbound customer interactions in a professional and timely manner.
• Assist members with inquiries regarding healthcare benefits, eligibility, claims, billing, and provider information.
• Verify member accounts and update customer records accurately.
• Explain healthcare plans, policies, and coverage in a clear and easy-to-understand manner.
• Resolve customer concerns while ensuring a positive customer experience.
• Coordinate with healthcare providers, insurance partners, and internal departments to resolve issues.
• Document all customer interactions accurately in the system.
• Maintain confidentiality of sensitive customer information and comply with HIPAA and company policies.
• Meet or exceed quality, productivity, and customer satisfaction performance metrics.
• Stay updated on company policies, healthcare regulations, and account procedures.

Qualifications

• High School Graduate or Senior High School Graduate (College graduates are an advantage).
• At least 6 months of BPO customer service experience is preferred; healthcare account experience is an advantage.
• Excellent verbal and written English communication skills.
• Strong customer service, problem-solving, and active listening skills.
• Basic computer proficiency and the ability to navigate multiple applications.
• Willing to work on shifting schedules, weekends, and holidays.
• Amenable to working onsite, hybrid, or work-from-home setup, depending on business requirements.

Preferred Qualifications

• Experience handling healthcare, insurance, HMO, or medical-related accounts.
• Knowledge of healthcare terminology, claims processing, member services, or insurance benefits.
• Strong attention to detail and ability to multitask in a fast-paced environment.

Benefits

• Competitive salary package
• Performance-based incentives
• HMO coverage and life insurance
• Paid training
• Paid vacation and sick leaves
• Government-mandated benefits
• Career growth and advancement opportunities
• Supportive and collaborative work environment