• Handles inbound and outbound calls for:
• Eligibility verification
• Provide network information
• Inquiries on Clients’ Medical Plan/Schedule of Benefits (SOB)
• Other related queries/requests from brokers, accredited Network Providers, Clients, and other intermediaries
• Issuance of Letter of Authority (LOA) for all eligible in-Patient (IP) and Out-Patient (OP) availments
• Coordinates with accredited medical provider – hospital admission of Clients
• Computes for Clients’ eligible medical benefits during hospital discharge and ensure all excess of benefits (EOB) are collected prior to discharge
• Attend to Clients’ and intermediaries’ queries/requests/complaints course thru other sources than voice calls (Mobile App, email, SMS, etc.)
• Undertakes all other tasks that may be assigned from time to time

Education: Graduate of any 4-year course (preferably in Nursing, Medical Allied courses, or Business Administration).

Experience: At least 1 year experience in a call center, healthcare, or customer service environment (HMO/insurance industry experience is an advantage).

Knowledge:

• Basic understanding of medical terminologies, hospital processes, and HMO/insurance benefits.
• Familiar with eligibility verification, LOA issuance, and computation of medical benefits.

Skills:

• Excellent communication skills (verbal and written) in English and Filipino.
• Strong customer service orientation and problem-solving skills.
• Proficient in MS Office applications (Word, Excel, Outlook) and able to navigate multiple systems.
• Ability to handle inbound and outbound calls, emails, SMS, and other communication channels efficiently.