Job Description
Full details about the role and requirements
Yukerja Summary
The TPA Administrative Services Specialist role at Proserve Business Consultancy Service is curated from Bossjob (category Sumber Daya Manusia). Note the work location (Cebu, Central Visayas, Philippines) before applying. Yukerja.com is not the employer — applications are handled on the official source site.
TPA
Administrative Services Specialist
Reports To
Operations
Supervisor / Team Lead
Position Summary
is seeking a highly motivated and customer-focused TPA Administrative Services
Specialist to support Third-Party Administrators (TPAs), health plans,
self-funded employers. This role serves as an extension of clients' operations
by delivering high-quality administrative, customer support, and healthcare
operations services across multiple functional areas.
The ideal candidate is detail-oriented, adaptable, and committed to delivering
exceptional service while maintaining compliance with healthcare regulations,
client requirements, and operational performance standards. Team members will
receive cross-training across multiple healthcare administrative disciplines.
Essential Duties and Responsibilities
Provide exceptional customer service to members, providers, employer groups, and
healthcare partners.
Assist members with benefits, eligibility, enrollment, claims status, ID cards, and
general plan inquiries.
Support providers with payment inquiries, demographic updates, credentialing support,
and issue resolution.
Process eligibility, enrollment, terminations, and coverage changes accurately.
Support claims administration activities (non-adjudication).
Coordinate prior authorization and pre-certification support.
Request, organize, and validate medical records and supporting documentation.
Support care management, utilization management, and case management activities.
Maintain provider directories and provider data.
Support employer group administration and benefit changes.
Document all customer interactions accurately.
Utilize payer systems, CRM platforms, and Microsoft Office applications.
Meet productivity, quality, turnaround time, and customer satisfaction goals.
Recommend workflow improvements.
Collaborate with internal teams and client stakeholders.
Participate in training and quality initiatives.
Perform additional healthcare administrative duties as assigned.
Qualifications
Education
High School Diploma or equivalent required.
Associate's or Bachelor's degree preferred.
Experience
2+ years of healthcare administration, customer service, health insurance, or revenue cycle experience.
·TPA,payer or provider experience.
Contact center experience preferred.
Knowledge, Skills and Abilities
Healthcare administration
Medical terminology
Healthinsurance
Eligibility & enrollment
Member and provider services
Claims support
Prior authorization
HIPAA compliance
Microsoft Office
Customer service
Analytical and problem-solving skills
Strong communication
Attention to detail
Key Performance Indicators (KPIs)
Quality Assurance
Productivity
Service Levels
First Contact Resolution
Documentation Accuracy
Schedule Adherence
Attendance
Customer Satisfaction
Turnaround Time
HIPAA Compliance
Core Competencies
Customer Focus
Professionalism
Accountability
Integrity
Teamwork
Adaptability
Critical Thinking
Communication
Continuous Improvement
Working Conditions
Office-based or remote depending on assignment.
Flexible schedules as required.
Prolonged computer use.
Frequent interaction with members, providers, and employer groups.