Healthcare Support Representative

Job Description

• Assisted members, patients, and healthcare providers by responding to inquiries via phone, email, and chat while delivering exceptional customer service.
• Verified member eligibility, benefits, and coverage details in accordance with healthcare policies and procedures.
• Resolved concerns related to claims, billing, authorizations, provider networks, and plan benefits accurately and efficiently.
• Documented customer interactions, case updates, and resolutions in CRM and healthcare systems while maintaining data accuracy.
• Escalated complex issues to appropriate departments and ensured timely follow-up until resolution.
• Educated members on healthcare plans, available services, and self-service resources to improve customer experience.
• Maintained compliance with HIPAA and company policies by safeguarding confidential patient and member information.
• Met or exceeded key performance indicators (KPIs), including quality assurance, customer satisfaction (CSAT), average handle time (AHT), and first-call resolution (FCR).
• Collaborated with cross-functional teams to ensure seamless issue resolution and continuous process improvement.
• Demonstrated professionalism, empathy, and active listening skills when handling sensitive healthcare-related concerns.

Responsibilities

• Responded to customer inquiries regarding healthcare plans, benefits, claims, billing, and eligibility via phone, email, or chat.
• Verified member information and updated customer records accurately in company systems.
• Resolved customer concerns while ensuring a high level of professionalism, empathy, and customer satisfaction.
• Explained healthcare policies, coverage, and available services in a clear and understandable manner.
• Assisted members with claims status, prior authorizations, referrals, and provider network information.
• Documented all customer interactions, inquiries, and resolutions in accordance with company guidelines.
• Escalated complex or unresolved issues to the appropriate department for timely resolution.
• Protected confidential patient and member information by complying with HIPAA and company privacy policies.
• Met or exceeded key performance metrics, including quality, productivity, customer satisfaction, and first-call resolution.
• Collaborated with internal teams to ensure accurate and efficient service delivery.

• Highschool diploma or equivalent with at least 6 months of BPO experience (International Account) (Undergraduates, can be processed but more thorough with screening, no plans in continuing further education)

• College Graduate with or without work experience. (Four-year graduate with or without experience (must have excellent comms)

Minimum Salary is 19200

Maximum Salary is 20400

HMO Plus 2 Dependents,

Life Insurance

,Night Differential Pay

13th Month Pay,

Paid Leaves,

Government Mandated Benefits