Claims Specialist | Hybrid
- Philippines
- ₱35,000 per month
- Permanent
- Full-time
Our client is a modern benefits platform and full-service brokerage firm committed to helping companies create healthier workplaces. They combine expertise from benefits firms, technology startups, and insurance carriers to deliver a range of innovative solutions that empower employers and employees alike. Licensed in all 50 states, our client maintains strong relationships with major insurance carriers, providing comprehensive and reliable services. Their signature app serves as a go-to resource for employees, offering easy access to benefits information, tools, and resources to help members thrive.About the Role
The Advocate will be responsible for resolving member inquiries related to claims, coverage, plan details, eligibility, and authorizations. This role involves utilizing internal systems, process flow documents, and a ticketing system to address member issues and proactively identify additional service needs. The ideal candidate will have excellent communication skills, strong organizational abilities, and a passion for providing exceptional customer service. Adaptability, teamwork, and the ability to learn quickly are essential for success in this role.Key Responsibilities
- Provide high-quality customer support to ensure member satisfaction.
- Maintain a positive, empathetic, and professional attitude with customers at all times.
- Respond promptly and accurately to member inquiries via phone, service platform, and email.
- Resolve inquiries related to claims, appeals, providers, benefits, costs, and more.
- Document resolutions, member communications, and resolution times in the ticketing system.
- Collaborate with internal consultants and the service team to resolve issues.
- Reach out to carriers and providers for additional information as needed.
- Navigate internal systems to gather member, plan, and group details.
- Advise members on plan selection based on individual and financial needs.
- Schedule provider appointments on behalf of members.
- 3+ years of experience in customer support, preferably in healthcare and claims.
- Proven ability to provide exceptional customer service with a focus on empathy and problem-solving.
- Strong written and verbal communication skills in English, including tone matching and empathy.
- Ability to multitask and prioritize effectively in a fast-paced environment.
- Ability to work independently and collaboratively within a team.
- Strong attention to detail with a focus on accuracy in all tasks.
- College degree preferred, or completion of at least 2 years of college education.
- Salary: Competitive compensation based on experience.
- Equipment: All necessary equipment will be provided.
- Workstation: Your workstation should be set up in a safe and secure home environment with stable and reliable internet (minimum speed of 25 Mbps).
- Work Setup: Hybrid Setup
- Working Hours: Monday to Friday, US Hours Required.
- HMO Healthcare Coverage: Comprehensive coverage for you.
- Leave Days: 20 combined Sick Leave (SL) and Vacation Leave (VL).
- Government-Mandated Benefits: All mandatory benefits are included.
- Public Holidays: Paid time off for all Philippines Public Holidays.